By Roger C. Sohn, MD
The long head of the bicep is a fairly unique tendon. As seen in the illustration, the long head of the bicep tendon has to curve sharply as it enters the shoulder. This is one of the only tendons in the body that bends at a sharp angle and sits inside the joint. It probably explains why people get irritation and swelling on the portion of the tendon that rubs on the “corner” of the shoulder. This causes a sharp pain in the front of the shoulder. The pain can radiate down into the bicep muscle and occasionally into the forearm.
Many patients can recover from this condition through a physical therapy rehabilitation program. The selective use of cortisone injections can also aid in the recovery process. In some cases, other treatments such as an arthroscopic bicep tenodesis can be required.
A bicep tenodesis procedure stops the painful rubbing of the tendon by attaching it permanently to the humerus. This is typically done using a minimally invasive technique called arthroscopy. The tendon connects to the bone over the course of 12 weeks. During that time, patients follow a physical therapy protocol aimed at regaining range of motion. This is followed by a strength training regimen. Long term results have been excellent.