Long Head of Biceps Pathology

Tendinopathy and Instability

Normal Anatomy

• Long Head of Biceps Tendon (LHBT) attached to superior labrum and glenoid

• Tendon is surrounded by synovial sheath

• Surrounded by a sling of soft tissue

Normal Anatomy

Pathophysiology

• LHBT can undergo the following– Tendinopathy– Instability– SLAP Lesions– Rupture

Tendinopathy

• Inflammation of tendon rare

• Inflammation of tendon synovial sheath more common (Tenosynovitis)

• Degeneration of tendon structure also occurs

• Tendinopathy refers to any tendon disorder with pain, swelling and impaired performance

Tendinopathy

• Repetitive traction and friction causes tendon to initial swell

• Continued irritation causes tendon to become thicker

• Adhesions form to surrounding structures

• Often occurs with other rotator cuff disease (Secondary Biceps Tendinopathy)

• Can occur in isolation (Primary Biceps Tendinopathy)

Tendinopathy

Instability

• Medially directed force displaces the tendon into subscapularis insertion

• Medial force increased with repetitive throwing in abduction external rotation

• Due to soft tissue sling, instability occurs with other soft tissue disease, most commonly subscapularis disruption

Associated Pathologies

• Anterior Instability• Internal Impingement• Rotator Cuff Pathology, External Impingement,

Bursitis

Subjective

Tendinopathy• Usually insidious onset• Localized anterior shoulder

pain over bicipital groove• Vague symptoms• History of repeated

overhead movements or sports

Instability• Acute Trauma• Clicking and popping of

anterior shoulder• Audible snap with throwing

motions• Signs of adjacent rotator

cuff disease

Objective

Tendinopathy• Pain on palpation of the

bicipital groove• Reduced internal rotation

Instability• Tenderness and painful

clicking with full abduction and external rotation

Special Tests

Tendinopathy• Yergasson’s• Speed’s

Instability• Apprehension

Further Investigation

• MRI with Arthrogram• Arthroscopic Surgery

Management

Tendinopathy• Conservative always

considered first• Injections and Surgery can

be used if conservative management fails

Instability• Conservative usually

unsuccessful• Treatment focussed on

associated pathology first• Surgery usually considered

Tendinopathy Conservative Management

• Rest from aggravating activities• Stage 1 – Restore Normal Mobility• Stage 2- Restore Normal Motor Control and

Strength• Stage 3 – Dynamic Stability• Stage 4- Return to Sport Rehabilitation

Surgical Management

Tendinopathy• LHBT Decompression• Subacromial Decompression• LHBT Debridement• LHBT Tenotomy• LHBT Tenodesis• LHBT Transfer

Instability• LHBT Tenotomy• LHBT Tenodesis• Subscapularis Repair

Post Operative Rehabilitation

• Varies between surgeons and types of surgery• See the reading list for examples of post

operative rehabilitation programmes