Question 1

How do I know if my shoulder pain is coming from the biceps tendon?

Accepted Answer

Pain from the biceps tendon can be difficult to distinguish from other shoulder problems. It is often felt in the front of the shoulder, although this is not very specific. Ultimately, an MRI along with the examination findings is the best way to determine whether the biceps tendon is involved.

Question 2

Are proximal and distal biceps ruptures treated differently?

Accepted Answer

Yes. Proximal biceps ruptures are not repaired. Patients generally lose very little function. However, they can indicate an underlying degenerative process in the shoulder, so an MRI is often obtained to evaluate the rotator cuff. Distal biceps ruptures can cause more significant weakness, particularly with turning motions such as using a screwdriver or turning a doorknob, and are more likely to be repaired.

Question 3

What happens if the proximal biceps tendon ruptures?

Accepted Answer

Pain from a proximal biceps rupture usually settles down over time with little residual functional impairment. There is often a visible deformity called a "Popeye sign," where the biceps muscle bulges lower in the arm.

Question 4

Does a torn biceps tendon always need to be repaired?

Accepted Answer

No. Proximal biceps ruptures are not repaired. Distal biceps ruptures are more commonly repaired, particularly in younger or active patients, because they can result in persistent weakness.

Question 5

What is a biceps tenodesis?

Accepted Answer

A biceps tenodesis involves releasing the long head of the biceps tendon from inside the shoulder and reattaching it just below the shoulder on the upper arm. It is performed arthroscopically and is often done as part of another shoulder procedure, such as a rotator cuff repair.

Question 6

How long is recovery after biceps tenodesis?

Accepted Answer

For the first six weeks, I generally allow only very light use of the biceps, approximately 1-2 pounds with elbow flexion. Use and strengthening are then progressively increased, with unrestricted biceps activity generally allowed around three months.

Biceps Tendon Problems