Biceps Tendon Pathology – Everything You Need To Know – Dr. Nabil Ebraheim

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Educational video describing conditions of the proximal and distal biceps muscle.
The biceps muscle has two tendon in the shoulder:
Long head
Short head
Pian at the forn of the shoulder commonly occurs from conditions affecting the long head of the biceps tendon. The biceps tendon arises from the superior labrum at the top of the glenoid. It passes underneath the transverse humerla ligament in the groove between the lesser and the greater tiuberosity of the humerus.
The biceps tendon ends by inserting into the proximal radius at the elbow region.
What is the function of the biceps?
•Humeral head depressor
•Strong flexor of the elbow
•Supinator of the forearm.
Conditions affecting the biceps
Biceps tendonitis
It is inflammation or irritation of the upper biceps tendon. Recurrent microtruama to the tendon, overusue and repetive overhead activities, leads to biceps tendonitis. These activities include sports such as baseball, tennis, swimming, or lifting weights. Usually occurs in association with other shoulder problems as shoulder impingement, tears of the glenoid labrum, shoulder instability, shoulder joint arthritis and rotator cuff tears. Shoulder impingement is a main cause of biceps tendonitis.
The soft tissue between the humeral head and the acromion can be pinched or squeezed with arm movements.
•Anterior shoulder pain
•Bicipital groove tenderness
Speed test
The arm is supinated and the elbow is extended. The patient is asked to actively flex the shoulder while the examiner is applying resistance to the movement. Tenderness over the bicipital groove indicates tendonitis of the long head of the biceps.
Conservative treatment
•Physical therapy
•Steroid injections (around the tendon, not through the tendon).
Surgical treatment
If the condition does not improve with conservative treatment. Biceps tenotomy: damaged biceps tendon is released form its attachment. Cut the biceps tendon and let it fly. Done in elderly and low demand patients. Patients may have subjective cramping. May result in a popeye bulge. Damaged section of the biceps is removed. Remaing tendon is reattached to the upper bone (humerus). Usuallyu done for high demand patients.
Biceps tendon rupture
The biceps tendon may rupture at the top of the bicipital groove or it may rupture at the radial tuberosity in the elbow.
At the bicipital groove. Muscle moves towards the elbow (popeye). There is minimal loss of function with a long head rupture because the short head of biceps remains attached to the coracoid process.
At the radial tuberosity of the elbow. “pop” felt at the elbow when the tendon ruptures. Rupture must be repaired otherwise there will be loss of flexion and supination.
Hook test
The patient actively supinates and flexes the elbow at 90 degrees. If the distal biceps tendon can be hooked form the lateral side of the elbow, then the biceps tendons is intact.
•Proximal ruptures can be treated either conservatively or surgically. Non-operatively for elderly and most patients will become asymptomatic after 4-6 weeks. Includes rest, ice and physical therapy.
•Surgical treatments is reattaching the torn section of the tendon to the bone (tenodesis). It is usually done in association with other reconstructive surgery. Rarely done for cosmesis.
•Avulsion of the distal biceps tendon is treated with tenodesis using sutures to anchor the tendon into the radius.
Biceps tendon subluxation or dislocation
The transverse humeral ligament and pulley system which holds the biceps tendon within the bicipital groove can become injured.

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Balinda74 says:

I just had surgery they repaired the slap tendon removed a cyst but there was no more long head tendon. What will my mobility be like

Warrior says:

6 weeks is alot i wanna workout 😭

sumant jaiswal says:

The video was really good.. but 'doctor i have been a bad boy ' sounds very wrong..

Denzil Faria says:

Excellent explanations, even though, as a layman, I didn't understand all the medical terminology.

zeake13 says:

Great info. . . . My shoulder is shredded.. . . I think biceps tendon subluxation or dislocation or …..

derek crymble says:

Dear Santa ……I can explain .

Moe Biceps says:

I have chronic biceps tendon rupture from shoulder can I do surgery if its been 2 late ?

Christobal Espinosa says:

I have a proximal bicep tendon rupture… It happened in a sumo tournament i attended. I tried gaining an inside left, outside right grip on the mawashi and when my foe went for the throw, i clinched my right arm instead of letting go and i felt the tare happen… .. it happened may 18th 2019. I still haven't got it fixed…

IAMdevilwomen says:

I had shoulder surgery going on 3 months ago, but the pain is NOT going away, I've been in PT since surgery to get movement back, I am able to move the arm, but can't itch my own back anymore, can't lift anything heavier then a water bottle, and EVERY time I move left arm I can hear AND FEEL a snapping, think of the noise your knuckles make when you crack them…it's painful and has started triggering BAD charlie horses in the left bicep, pt isn't doing really anything other then keeping what small movement I do have from getting worse, pain is getting unbearable, been "living" off of Tylenol and Tums, due to the pain causing sick stomach, Dr FINALLY ordered a CT scan, was just wondering what you think it might be….


I have a proximal rupture do I need surgery ?

TH says:

I've now had both shoulders repaired – the Right cuff and lh bicep and the Left lh bicep – this is far and away the clearest and best overview of what is involved when dealing with lh bicep tendon surgical options. A must watch for anyone who wants a basic understanding when considering surgery. My right shoulder is 150% since surgery 5 years ago – which allows full training including butterfly in the pool. Hopefully last week's Left bicep repair will be as successful – both were tenodesis.

Wilfredo Nelson III says:

Wow, this was exactly what I was looking for. Clear, concise, and thorough information. I don't live anywhere near Toledo, otherwise I would come to you for my current bicep issue. Thank you so much for posting this video 🙂

Scott Craigen says:

My bicep rolled up my arm a bit 2 years ago. Zero pain and full range of motion so I’m just dealing with a semi case of popeye deformity

Metal Head19 says:

I’m sure a lot of bench pressers are here

Cheap Chic Finds On The Fly says:

The video was helpful.. I think I may have it. I been getting pain in the area you were showing. I was do kettlebell.,I been hurting for couple of months.some nights I can’t sleep so I get out of bed and put ice on it and take Advil..sometimes when my arm is bend and I have pain lasts until I can get my arm straight, hurts so bad until I can get it to go straight I nearly scream. With high cases of covid not sure if I should deal with it like I have been and just putting ice on it.or just what any suggestions would be great will be turning 54,

أحمد عبدالحسين شحاته says:

Great thanks to you

Klajdi Kaca says:

I tore proximal bicep long head(40-50%). Does it need surgery

Chino Victorino says:

Merry Christmas!!

Gerald Esterman says:

I injured my shoulder from bench pressing. According to my physio I have biceps tendonitis in the long head. The illustrations and animations were very helpful in illustrating the condition. Thank you.

Shadan Su says:

perfect …
thank you

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