Spotlight On The Long Head Of Biceps

Issues With The Long Head Of Biceps Tendon Are Relatively Common

The proximal tendons of the biceps brachii include the short head of biceps and the long head of biceps tendons. The two tendons are commonly involved in pathological processes and considered a frequent cause of shoulder pain. Of the two, it is the long head of the biceps that is more commonly injured. The long head is seen as being more vulnerable to injury as from its origin on the superglenoid tubercle of the scapula it travels through the shoulder joint down through the bicipital groove on it way into the anterior aspect of the upper arm and insertion below the elbow. Passing through the shoulder joint it is more exposed to compression and unlike the short head of biceps the long head coming from above the shoulder joint has the ability to act on both the shoulder and the elbow. Like most two joint muscles it is more at risk of injury and overload than many single joint action muscles. In contrast the short head of biceps rarely tears. However, tightness of the short head of biceps is considered to potentially negatively impact scapula posture and dynamics pulling the shoulder blade down and forward while impacting upward rotation.  Therefore a tight short head of biceps is potentially also a contributing source in shoulder pathology.

Bicep Tendon Tears

Damage to the long head of biceps can present in a number of ways, including tears to the tendon which may be either partial, or complete tears. In many cases, torn tendons begin with degeneration (fraying) of the tendon and unlike complete tears, partial tears do not completely sever the tendon in two.  Degeneration is rarely associated with single a traumatic event, but a product of overload extending over a lengthy period of time. As the degenerative process progresses it can make the tendon more venerable to tearing, which may then be a more sudden injury such as a tear to the tendon when attempting to lift a heavy object, or associated with a trying to break a fall. When there is a tear to the long head of biceps tendon, damage to other parts of your shoulder may occur concurrently, such as damage to the rotator cuff tendons and/or the labrum (the soft cartilage in the socket in your shoulder bone).

As mentioned previously the two main causes of biceps tendon tears are overuse and injury these situations can occur as a result of the following:

• Injury may occur from something like a fall on to an outstretched arm, or a heavy lift.
• Overuse happens less suddenly, occurring slowly over time the result of repetitive loading motions to the muscle or tendon.
• Poor scapula and shoulder biomechanics as well as shoulder pathology such as rotator cuff injuries, or shoulder dislocations can place strain on the biceps tendons at the shoulder.

Signs And Symptoms Of Long Head Of Biceps Tears

With regard to a complete rupture of the long head of biceps examination will often reveal a deformity of the biceps muscle referred to as a “Popeye Muscle”. This is often quite obvious and is made more apparent by contracting the biceps muscle as seen in the image above. The absence of a “popeye muscle” yet the presence of pain when using the biceps muscle may indicate a partial tear, degenerative tendon changes or other pathology such as long head of biceps tendon sheath inflammation, or even labral tears in the shoulder… The signs for these injuries are less obvious that the “popeye muscle sign” and may require further investigation such as the use of imaging techniques including an X ray or MRI to assist in diagnosis and treatment planning.

Treatment Of A Long Head Of Biceps Tendon Injury

For many tears and even ruptures the pain and reduced function from a long head tendon injury resolves over time. Because of the existence of the short head of biceps, the majority of individuals who rupture their long head can still use their biceps and arm relatively normally even following a complete tear. Although with some tears and complete ruptures mild arm weakness may persist, yet I often find that older or equally less active individuals will often not be significantly bothered by any deficit. Some individuals with partial or complete tears however do have persistent symptoms, symptoms may include pain and cramping, or unsatisfactory strength deficits that as a result of their work or leisure activities mean they don’t have suitable function. In these situations in consultation with an orthopaedic surgeon they may decide to undergo surgery to help remedy the situation a common procedure is a biceps tenodesis.

Disclaimer: Sydney Physio Clinic provides this information as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on Spotlight On The Long Head Of Biceps should consult his or her physiotherapist, general practitioner or sports medicine specialist.