The shoulder’s biceps muscle has two attachments: the “short head” is outside of the shoulder joint and rarely causes shoulder problems, while the “long head” travels in front of the shoulder between the rotator cuff tendons and into the shoulder joint, attaching on the superior labrum, which is a ring of fibrocartilage around the edge of the shoulder socket that helps stabilize the shoulder.
Biceps tendinitis of the long head biceps tendon is a common cause of shoulder pain, either by itself or in combination with other shoulder problems, such as rotator cuff tears.
What is a SLAP Tear?
Superior labrum anterior to posterior (SLAP) tears are tears of the top part of the superior labrum, where the long head biceps tendon attaches. SLAP tears typically cause shoulder pain, popping and clicking and loss of shoulder function.
What causes biceps tendinitis and SLAP tears?
Biceps tendinitis often occurs with overuse of the shoulder from work or sports. SLAP tears often are experiencing by overhead-throwing athletes, such as those who play baseball, softball, tennis and volleyball.
What are the symptoms of biceps tendinitis and SLAP tears?
- Pain in the front of the shoulder and down to the biceps muscle
- Pain that is often worse with lifting the arm in front of the body or above the shoulder
- Snapping of the biceps tendon with shoulder motion
- Pain that interferes with daily life, recreation or job activities
- Pain that prevents or disrupts sleep
In some cases, the biceps tendon can actually rupture, causing pain and deformity (sometimes called a “Popeye” deformity) of the biceps muscle. In cases of acute rupture, you should get the injury evaluated right away.
How is biceps tendinitis or a SLAP tear diagnosed?
Diagnosing both biceps and superior labrum injuries involves a physician gathering a medical history and performing a physical examination of the shoulder. There may be tenderness over the biceps during the exam, or pain with certain exam maneuvers.
X-rays and magnetic resonance imaging (MRI) are taken to confirm the diagnoses and identify any other associated injuries, such as a rotator cuff tear.
How is biceps tendinitis or a SLAP tear treated?
Most people who have biceps tendinitis or SLAP tears don’t need surgery to relieve pain, improve shoulder function and regain the functions of work, play and daily life. Nonsurgical treatment includes rest, ice, physical therapy and home exercises. Cortisone injections, performed with an ultrasound directly into the biceps tendon sheath or shoulder joint, can also provide pain relief in certain patients.
If nonsurgical options fail or if you’ve experienced an acute biceps tendon rupture, surgeons at The Ohio State University Wexner Medical Center can perform surgery. This begins with a minimally invasive shoulder arthroscopy to directly look at these structures with a high resolution camera and see what’s torn or inflamed.
Depending on the patient and the specific injury, treatment could include:
- Debridement, which means removing the rough edges or flaps of a torn superior labrum
- Arthroscopic repair of the SLAP tear with anchor to sew the torn labrum back to the shoulder socket. The repair uses absorbable anchors that are placed into the socket near the labrum. Stitches from the anchors are then used to repair the labrum back to the socket so that it can heal
- Biceps tenodesis, which involves removing the damaged long head biceps tendon from the shoulder joint and re-inserting it into the upper arm
Other associated shoulder problems, such as rotator cuff tears, shoulder impingement or labral tears, can be arthroscopically addressed at the same time as biceps treatment.
The recovery process for labral repair surgery includes wearing a sling for about six weeks and beginning gentle physical therapy two to three weeks after surgery. Physical therapy involves four to six months of therapy to continually strengthen the shoulder.
Why choose Ohio State for biceps tendinitis and SLAP tear repair?
The Ohio State University Wexner Medical Center specializes in the most advanced treatment options available for biceps tendinitis and SLAP tears.
Ohio State provides a team of experts who work solely with the shoulder, including anesthesiologists, physical therapists, surgeons and other health care providers who are dedicated to treating shoulder issues with a focus on minimized risk and pain and fast recovery. Our orthopedic experts also lead medical research to improve shoulder treatment and determine more specific causes for injuries.