Biceps Tendon

Bicep Tendonitis treatment in Indianapolis, IN and Mooresville, IN

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Proximal Biceps Tendinitis

Proximal Biceps Rupture
Proximal Biceps Surgical Treatments

Proximal Biceps Tendinitis / Internal Rotation Deficit

Biceps tendinitis is an inflammation or irritation of the upper biceps tendon. Also called the long head of the biceps tendon, this strong, cord-like structure connects the biceps muscle to the bones in the shoulder. Pain in the front of the shoulder and weakness are common symptoms of biceps tendinitis.

In its early stages, the tendon becomes red and swollen. As the tendinitis progresses, the tendon and its sheath (covering) can thicken. The tendon in these late stages is often dark red in color due to the inflammation. Occasionally, the damage to the tendon can result in a partial or complete tendon tear, and then a “Popeye” deformity of the arm (large bulge in the upper arm).

In most cases, damage to the biceps tendon is due to a lifetime of normal activities. As we age, our tendons slowly weaken with everyday wear and tear. This degeneration can be worsened by overuse — repeating the same shoulder motions again and again. Many jobs and routine chores can cause overuse damage. Sports activities, particularly those that require repetitive overhead motion (swimming, tennis, and baseball), can also put people at risk for biceps tendinitis. Repetitive overhead motion may play a part in other shoulder problems that occur with biceps tendinitis. In these cases, patients almost always have a difficult time with internal rotation (activities behind the back like fastening a bra or looping a belt).

Non-operative treatment:
Most patients with biceps tendinitis can be treated successfully without surgery. This includes activity modification, anti-inflammatories, injections, and physical therapy. Physical therapy plays a vital role in treatment in order to stretch out the muscles and ligaments of the shoulder. Steroid injections are cautiously used in this condition because the medication can weaken an already-injured tendon, increasing the risk of rupture (tearing).

Operative treatment:
In cases where pain does not improve with non-operative treatments, surgery may be offered. The inflamed tendon is removed and the biceps is repaired. This surgery may be done through a minimally invasive arthroscopic surgery with a camera or with a small, open incision.

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Proximal Biceps Rupture

Tendons attach muscles to bones. The biceps tendons attach the biceps muscle to bones in the shoulder and in the elbow. The upper end of the biceps muscle has two tendons that attach it to 2 different bones in the shoulder. The long head attaches to the top of the shoulder socket (glenoid). The short head attaches to a bump on the front of the shoulder blade called the coracoid process. The long head of the biceps tendon is more likely to be injured. It is vulnerable as it makes a sharp turn entering the shoulder joint to its attachment in the socket. Fortunately, the biceps has two attachments at the shoulder. The short head of the biceps rarely tears. When the long head of biceps tendon completely tears, it very frequently causes swelling and bruising over the front of the arm. Rotator cuff tears usually do not cause this type of bruising.

Non-operative Treatment:
For many people, pain from a biceps tendon tear resolves over time. Mild arm weakness or arm deformity (Popeye deformity) may not bother some patients, such as those less active and older. Treatment initially involves ice or cold packs for 20 minutes at a time, several times a day to decrease pain and swelling. Drugs like ibuprofen, aspirin, or naproxen can reduce pain and swelling, as well. Your doctor may recommend using a sling for a brief time. Avoiding heavy lifting and overhead activities prevent aggravating the injury. Physical therapy is also important to work on flexibility and strengthening exercises to restore movement and strength to your shoulder.

Operative Treatment:
Surgery is an option in younger and more active patients, such as in athletes or manual laborers, who have more demands on their shoulder. Ideally, surgery is performed within 2 weeks of the injury because otherwise the biceps tendon scars into the incorrect position. Biceps tenodesis is a procedure in which the biceps is repaired to the bone, just below the shoulder, which relieves pain, and retains strength and function. Most of the time the surgery is begun arthroscopically (minimally-invasively) and then an open incision is made near the axilla (arm pit) to repair the biceps tendon back to the bone. This surgery is performed under general anesthesia and is almost always accompanied by a nerve block to help with pain after surgery. Some patients may notice the biceps muscle sink down slightly (Popeye deformity) due to the movement of the muscle. This change in position of the muscle rarely causes any weakness.

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Proximal Biceps Tendinitis Surgical Treatment

Surgery begins with an arthroscopy, where a small camera is inserted into the shoulder. Once the exact pathology (problems) of the shoulder has been identified, the biceps can be “fixed” several different ways.

A biceps tenodesis is a procedure in which the damaged portion of the biceps is removed and the remainder is repaired to the bone (see image below). The goal of this surgery is to relieve pain, while retaining strength and function.

This procedure can be done either arthroscopically (several small pokehole incisions) or with an open incision. In the vast majority of patients, there is minimal to no loss in muscle strength after a biceps tenodesis. Some patients may notice the biceps muscle sink down slightly (Popeye deformity) due to the movement of the tendon. This change in position of the muscle rarely causes any weakness.

In rare cases where a patient has very low activity level (older patient, very little lifting and/or tendinitis in the non-dominant arm), a biceps tenotomy may be offered. A tenotomy is a very quick arthroscopic procedure where the biceps tendon is cut and allowed to retract down the arm. Patients with a tenotomy tend to have more of a muscle bulge (Popeye deformity) and some can have cramping of the biceps muscle with activity. However, they retain the majority of their strength and motion.

The above procedures are done as an outpatient under general anesthesia. A pre-operative nerve block is given to help with pain after surgery.

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Helpful, kind and made it as easy as possible!

“Dr. Calloway did my surgery. He's personable, up front about what your problem is and how to solve it, and open to any questions with a great bedside manner. The surgery went perfectly to the point where I was basically a little weirded out about how well it went. I had a similar surgery on my left shoulder as I did in my right shoulder, a few differences, and this particular shoulder surgery with Dr. Calloway went smooth as butter. His office staff is very nice and personable as well. No one there makes you feel like a dollar sign. When the surgery time came Dr. Calloway came to my room and pre-op to explain what was going to happen and try to call my nerves, as I have an extreme fear of going under anesthesia. He and the surgery staff were helpful and kind and made a difficult experience is easiest possible.”

Excellent Surgeon!

“Excellent surgeon! He's friendly, personable, knowledgeable and does a great job of explaining what he's going to do and what he did do after surgery.”

I have no pain, no popping, my mobility is great!

“Dr. Calloway was great to work with. After dislocating my shoulder multiple times he suggested latarjet procedure. I am now 9 months post surgery and my shoulder feels great, my incision healed very well. I have no pain, no popping, my mobility is great and my shoulder feels secure again witch I am very thankful as I do tree work and need to use my shoulders a lot. Dr. Calloway patiently answered every question I had thoroughly and I believe he set me up for the best recovery possible.”

The surgery results were great!

“I had no problems getting scheduled for appointments or for surgery. He was very friendly and courteous and gave realistic expectations about my rotator cuff surgery. He took the time to explain exactly what procedures were to be used. He answered all my questions. The surgery results were great. He was very much engaged in getting me back on the golf course with his recommendations for physical therapy and encouragement. I would definitely recommend him to others and if I need surgery on my other shoulder he will be my first choice.”

This is the first I've been painfree!

“I was referred to Dr. Calloway as a last resort. He was honest up front and told me he couldn't guarantee that he could be any help. I underwent arthroscopic surgery to have scar tissue cleaned up and he performed a tendon release on my hip. One week after surgery I am having no pain and much more mobility. This is the first I've been painfree in more than 6 years.”