The biceps tendon has two origins. The main attachment (short head of the biceps) originates from a finger of bone projecting from the shoulder blade called the coracoid. Another attachment (long head of the biceps) originates from the top, or superior, portion of the labrum. This accounts for the two bellies of the biceps muscle (bi=two).
The long head of the biceps is susceptible to inflammation, or tendonitis, as it courses from the labrum as it travels underneath the rotator cuff through a shallow groove in the humerus. This may become inflamed for activities that isolate the biceps (weights). In addition, irritation from tears of the superior labrum or rotator cuff can cause a biceps tendonitis as well. Treatment of a tendonitis consists of activity avoidance, ice, anti-inflammatories, and physical therapy.
Repeated stress to the biceps may cause the biceps to tear. Pain recalcitrant to the simple measures indicated above may require surgical treatment. Tears under 50% of the substance of the biceps are treated with surgical polishing. Tears greater than 50% thickness are treated with either a biceps tenodesis or a biceps tenotomy. The figure below shows significant tearing of the biceps.
A biceps tenodesis is a procedure where the diseased segment of the biceps is resected. The remaining portion is reattached either to the rotator cuff or implanted within the bone of the humerus. This allows preservation of the strength of the biceps without leaving a cosmetic deformity.
A biceps tenotomy is a procedure where the diseased biceps is cut. Because there is no pull on this diseased tendon, the pain from the biceps is eliminated. Occasionally there may be a slight deformity in the arm. About 5% of the strength of the biceps is lost. The advantage is there is no need to protect the arm in a sling for four weeks like that necessary for a biceps tenodesis.