Dissecting Shoulder Pain: The Biceps Tendon and Related Structures
Frederick S. Song, MD
Princeton Orthopaedic Associates, PA
The biceps tendon, as it relates to the shoulder, has multiple areas that are susceptible to injury resulting in pain and diminished performance for the athlete. The biceps muscle complex is made up of two individual muscles, the short head and the long head of the biceps. The short head of the biceps tendon attaches into the coracoid process, located just below the clavicle as the hook like bone that can be palpated. Injuries are much less common with the short head of the biceps as compared to the long head. The long head of the biceps tendon (LHBT) inserts into the superior labrum, which is the cartilagenous ring around the glenoid (socket portion of the shoulder). Injuries are most common, as the tendon courses into the shoulder joint.
The two most common pathologies relating to the LHBT are tendonitis or tenosynovitis and superior labrum anterior to posterior (SLAP) tears. Tendonitis of this tendon typically manifests as pain in the front of the shoulder that can run down the front of the arm. This is often times due to an overuse injury and is not an acute, traumatic phenomenon. Tendonitis along the LHBT typically occurs in the bicipital groove, located in the front of the shoulder. This is a bony trough covered by a ligament that creates a tunnel that the tendon passes through in order to access the shoulder joint. When the tendon becomes inflamed from any overuse, it is common to have pain in this groove as it can constrict the tendon causing friction and exacerbate the pain. Patients have tenderness to palpation directly over the groove. This injury is almost always treated by conservative means. Ice, anti-inflammatory medication (e.g. Aleve, Motrin, Advil), and rest are the first line treatments. If pain persists, a steroid injection into the bicipital groove can confirm the diagnosis as well as treat the issue. Improper mechanics as well as over use can often times lead to this problem. Biceps tendonitis can affect athletes of all ages, but once again can frequently be treated without surgery.
The other common pathology found in relation to the LHBT is a SLAP tear. This occurs in younger patients as a result of a traumatic injury or in the case of the overhead athlete (e.g. baseball, tennis, volleyball). The repetitive nature of overhead arm movements can lead to SLAP tears. A fall on an outstretched arm is the most common traumatic mechanism of injury for a SLAP tear in the younger athlete. Pain is described as deep in the joint as compared to more superficial pain found in biceps tendonitis. Unlike biceps tendonitis, the patient’s pain can not be reproduced with palpating any particular spot on the shoulder. Pain is often times positional where patients describe more pain with overhead activities and movements with their arm extended fully in front of them with weight. An MRI is an extremely helpful tool to help diagnose SLAP tears. Initial conservative treatment is similar to those used in biceps tendonitis, but usually has a higher failure rate. Surgery is more common in the treatment of SLAP tears compared with biceps tendonitis.
Dr. Song graduated cum laude from Colgate University with honors in Molecular Biology. During his undergraduate career, he was a four year starter on the varsity soccer team. As a senior, he served as team captain and was the Patriot League Player of the Year. After graduating from Colgate, he received his Doctorate of Medicine from Jefferson Medical College, where he was elected to the Alpha Omega Alpha Honor Medical Society during his fourth year. Dr. Song completed his surgical internship and orthopaedic residency at Albert Einstein Medical Center in Philadelphia, Pennsylvania. As a resident, he served as an assistant team physician for the LaSalle University basketball and football teams. Following residency, Dr. Song completed a sports medicine fellowship at the Steadman Hawkins Clinic of the Carolinas in Greenville, South Carolina. Under the guidance of Dr. Richard Hawkins, he received specialized training in knee and shoulder arthroscopy, as well as complex knee and shoulder reconstruction. During his fellowship, Dr. Song served as an assistant team physician for the Colorado Rockies Major League Baseball team and the Boston Red Sox affiliate Greenville Drive baseball team. He is currently the team orthopaedic surgeon for the Peddie School and Ewing High School and serves as a consultant for numerous other high schools and colleges in the area. Dr. Song currently serves as an associate instructor for the Arthoscopy Association of North America, instructing other surgeons on techniques in shoulder arthroscopy.
His orthopaedic interests include arthroscopic surgery of the shoulder and knee, as well as knee and shoulder reconstruction.