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The biceps muscle has two attachments around the glenohumeral joint. The so-called short head is attached to the coracoid bone in front of the joint. Ruptures to the short head occur very seldom. The long biceps tendon is much thinner than the short one. It derives from the upper part of the glenohumeral joint and goes through the rotator cuff structure in a complicated manner. It is the long tendon of the biceps muscle which most often encounters various problems such as spontaneous ruptures.

In conjunction with rotator cuff problems, the biceps tendon may be frayed or tendinotic, i.e. it has permanent degenerative changes in its structure. A tendinotic tendon is painful and weak and a spontaneous rupture of the tendon may occur. The biceps tendon may also be unstable and even dislocate. The long tendon may rupture even with the slightest stress and a so-called Popeye shape forms on the biceps muscle. There may be a hematoma on the muscle and it is often prone to cramps. Treatment of a spontaneous biceps rupture is generally conservative, i.e. non-operative. The bruises and cramping disappear with time. The biceps muscle loses some of its strength but this strongly depends on the initial level of strength in the muscle. Later, the degree of strength is more or less a matter of exercise. The disability caused by a rupture in the long head of the biceps is considered minor.

Treatment of a partially ruptured or dislocated biceps tendon rupture /
long head biceps tenodesis

In shoulder surgery, situations where the long biceps tendon is either of poor quality or unstable may be encountered. There are two alternatives: either the damaged tendon is severed or a tenodesis is performed. If the tendon is cut, it is let to retract and the biceps muscle forms the Popeye shape.

Tenodesis involves fixing the long head of biceps tendon on its course to the humeral bone. In this way, no Popeye shape occurs and after the healing period the tendon functions nearly normally. Reasons to perform a tenodesis may include a partial rupture of the biceps tendon or a large upper labral tear under the biceps tendon attachment (SLAP tear).

Postoperative treatment

The patient wears a sling for four weeks and is permitted to do light rotatory movements and passively lift his/her arm depending on the severity of the pain. The patient can write, use a computer, make coffee, eat, etc. However, the patient must be extremely careful not to harm the tenodesis. No heavy objects should be lifted to avoid loosening the fixed tendon.

The sling is removed after four weeks and active rehabilitation may begin –6 weeks after surgery. The patient may engage in heavy labor 3 months and sports 4–6 months after surgery.