The important muscle in the front of upper arm is biceps. It helps in bending and rotating the arm. This muscle has got two attachments in the upper end. One of them goes into the shoulder joint to get attached into the cartilage structure called superior labrum located at the top end of the glenoid (disc like cup) of the shoulder joint. Indirectly, the biceps also confers some stability to the shoulder joint. A tear occurring in the biceps tendon can be partial or complete. If there is a tear in the attachment of the biceps tendon in the shoulder joint it is called as SLAP lesion. The long head of the biceps tendon is more likely to be injured. This is because it is vulnerable as it travels through the shoulder joint to its attachment point in the glenoid. When the biceps tendon is torn during the injury, the injury could also damage other parts of the shoulder joint such as rotator cuff tendons.
When it is torn, it can cause a sudden sharp pain in the upper arm, bruising in the upper arm, weakness in the shoulder and elbow.
By doing physical examination and necessary investigation such as an Ultrasound scan, the diagnosis can be confirmed.
The treatment depends on the symptoms. Fortunately, the biceps has two attachments at the shoulder. The other attachment is outside the shoulder joint. Because of this second attachment, many people can still use their biceps even after a complete tear of the other attachment.
In some, it may result in weakness and if that is the main concern, the tendon can be reattached to the bone by a procedure called Arthroscopy assisted biceps tenodesis.
This surgery is performed in those who have weakness as a result of biceps tendon pathology. The objective of the procedure is to reattach the ruptured tendon to the bone with a tenodesis screw. Tenodesis is the medical terminology for attaching a tendon to the bone.
Arthroscopy of the shoulder joint is done with two or three tiny 0.5cm incision around the shoulder joint. A miniature tubular camera is introduced through these small cuts to visualize the shoulder joint. The biceps tendon is examined, assessed for any abnormality and probed for integrity.
With the help of special arthroscopy needle a stitch is applied through the biceps tendon and the biceps tendon is retrieved through another 2 cm incision over the upper end of the arm bone. The tendon that is retrieved in the upper arm is fixed to the arm bone the help of a clip or a tenodesis screw. The pain is minimal as the surgery is done through a small cut only.
Postop: After surgery, the shoulder may be immobilized temporarily with a sling. Physiotherapist will see and instruct on exercises to carry on. Flexibility exercises will improve range of motion in your shoulder. Exercises to strengthen your shoulder will gradually be added to your rehabilitation plan.
Successful surgery can correct muscle deformity and return your arm’s strength and function to near normal.
The complications with this surgery are very low
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