Long Head Tendon of the Biceps in the Shoulder: Treatment Options

[@johngreco6694]

This is the most informative, simple to digest, explanation of the issue I'm presently having. I'll be able to speak and understand with much more knowledge when I see my Ortho Dr. next week.

[@joshhaimes]

Thanks for making this video. Very clear and well explained. Helps me feel informed and enables me to better understand the choices that might be presented to me. Much appreciated!

[@glennwest1949]

If I were still teaching A&P and athletic training to undergraduates, I would integrate this excellent (as in well paced and easy to understand) video into my unit on upper extremities. But luckily, I am retired from the trenches and spend more time taking care of my own sports med aches, pains, and failing joints. Thanks for this very helpful contribution.

[@Mylogcabin]

That's is the best simplified explanation on KZbin .... 💪

[@jeepcj7909]

Excellent job explaining lot people don’t know how to relay message to others you get done watching and are like I don’t understand.Your video was perfect thanks taking time to make

[@chriswarmbold6909]

Thank you for sharing! I thought for sure I’d have to have surgery. But after my tendon tore all My shoulder pain went away. So glad I don’t have to have surgery if I choose not too. 💪🦅

[@MesonCounter]

Fantastic and highly instructional, thank you Dr. Derhake! I suspect I ruptured my long-head tendon a few days ago and I am much more informed after watching your video. I'm going to WashU orthopedic injury clinic tomorrow, if they can take me. I wish you were closer to St. Louis because I'd instead schedule with you.

[@johngreco6694]

And thank you Dr. Derhake, I only wish you had an office in Houston!

[@markl4593]

Me: “Doc, I’ve got a hangnail on my index finger”. Doctor: “No problem, let’s get rid of that bothersome finger. You’ll still have nine left”.

[@m.bird.]

Yeah, not a fan of cutting things out just because they hurt. We need to keep our original anatomy. There are better methods than what he mentioned.

[@SS-ki6ie]

Dr. Derhake, This is probably one of the best, most cogent and informational videos I have seen regarding bicep tendon tears. Clearly you are a world class expert in this area, and I’m sure all things related to the orthopedic realm. I recently tore my bicep tendon, near the shoulder, not the elbow, which I realized it had happen when a Popeye bump appeared on my bicep muscle. Is there a window of time for orthopedic surgery to fix the injury before it’s “too late?” I heard this claim made and wanted to check it with you. Thank you in advance for your time and attention and for making this topic easy to grasp and understand for us regular folks.

[@HeyIntegrity]

Did you get an answer as to up until when it can be repaired? I have lot of soreness near elbow and the upper bicep near shoulder Is super tight and stiff. Idk if that is like the Popeye sign.

[@SS-ki6ie]

@@HeyIntegrity I have not received one yet.

[@jieliu8644]

Thank you so much Dr. Derhake. I learned a lot from your lecture. You explained it very clear.

[@christopherfisher1694]

I just had a Bicep Tenodesis as part of my Supraspinatus surgery. Thank you for giving me an even better understanding of what was done, and why the recovery will take as long as it will.

[@HeyIntegrity]

Hey did the surgeon tell you beforehand? Also as to why they chose to do it? Did you have the slap tear as well?

[@christopherfisher1694]

@@HeyIntegrity The MRI confirmed a full thickness tearing of the Supraspinatus, and suggested possible tearing of the bicep. He mentioned when he had me open, he would thoroughly review and fix anything not seen. Its been 4 months now. I have recovered most ROM and getting stronger week by week (not pushing hard). There is a noticeable drop in the height of the bicep head (I do zottman curls which makes my peak pronounced). It doesn't affect me otherwise.

[@batman-sr2px]

@@christopherfisher1694 what were your complaints that they pushed for surgery? Did you try physiotherapy beforehand? Did your surgical notes also say if they checked the subscapularis. Asking because its not always checked but commonly involved when there is tear of bicep.

[@christopherfisher1694]

@@batman-sr2px I was reviewing something on my calendar for work, and realized I had received a Cortisone shot 5 years prior, and yet was still battling/nursing the pain the front of my shoulder. Over those 5 years, and I had been in and out of PT, as well as trying Yoga to fix what I thought was a very tight Pec Major/Minor. I think I had a tear in my bicep (long head) the entire time. Then late last year, I was moving something very large and heavy and tht was when I believe I torn my Supraspinatus. One of their tests were bending you arms at the elbow (90 degrees) so your hands are out in front and trying to enternally rotate comparing one arm verse the other. While that was significant, it was clear when I took my right hand, cross my face as if I was trying to scratch my back or traps. With my hand resting on top of the opposite should, I couldn't lift my elbow (vertically) in front of my face. I had ZERO strength or power in this position. At that point, I realized I really messed my body up and started preparing for surgery. I hope this helps.

[@jn.so.6001]

@christopherfisher1694 Hey i have a question was there really no other way to fix your problem than surgery? I did a mrt and they found a partial tear in subscapularis with a mild subluxation of the long head biceps tendon. My physiotherapist told me surgery isnt needed and you can fix it by excercising but here in this video he says otherwise and i have no clue. Any answer would be very helpful

[@Marx1963]

Excellent video- simple explanation and easy to understand . Having subpectoral bicep tenodesis soon

[@alanbush7791]

Hi Adam, Great info. Wish I found you before I went ahead with my tenotomy. All has worked out though. You are spot on with your presentation (with me as the patient). All the best.

[@HeyIntegrity]

Did you have a slap tear as well?

[@thill6771]

Another old A&P instructor guy says......... Very good, informative , presentation. Thanks.

[@1roomof21]

Great video! Thank you so much, I will come prepared with this information when I speak with my healthcare professional team 🙏

[@ablejohnson]

Great video thank you for sharing the information

[@laura_and_shanman]

Fantastic video and great, easy to understand information. Thank you!

[@joeadd5911]

How about addressing the difference with the tenodesis by either suture fixation or anchored drill placement. Mine was sutured and is the safer option to help avoid fracturing of the humerus. Thank you for your videos, they are great...

[@alaindion5529]

Hello Dr. Derhake. I just ''snapped'' a right arm bicep tendon and hard it pop while throwing a 30 pounds rock two days ago. I am waiting for an appointment for a scan. Your excellent explanation using visual aids and the different procedures related to tendon problems will definitely help me in deciding the approach to take when the problematic is clarified with my Doctor. Thank you very much for producing this superb video. Note: my Popeye bulge is not so bad!

[@HeyIntegrity]

What does a popeye buldge feel like?

[@Robert-bm5fz]

​@@HeyIntegrityachy cramp

[@Robert-bm5fz]

after an injury from pushing awkwardly a heavy beam. upon flexing the bicept (the classic flex armstrong) a cramp and i feeling and hearing ligaments in the shoulder popping around without intense pain mostly in the upper bicept itself. an ache afterwards.

[@bestrong1240]

I tore my long head tendon obviously below the groove and no pain happened 3 weeks ago getting ready to go into physical therapy feels good got some shoulder pain it's about it

[@raphaelrousso7124]

Très intéressant et utile ! Et surtout jamais expliqué par aucun rhumatologues ou même kinés consultés ! Alors merci beaucoup !

[@bobkim8772]

VERY INFORMATIVE I HAD EXACTLY WHAT YOU DESCRIBED THANK YOU

[@jorgeabrizuela]

Thanks for the information,it was very helpful, it was very clearly explained 👏 👍 thank you

[@brucemckay7828]

I experience about a 20 -25 % reduction in strength in my arm that lost the long head of bicep. I weight train before and after.

[@FalconTypo3]

So glad that you note this. As weight lifters, worried about being able to lift at all after a tenotomy-- that the doctor did NOT explain before surgery.

[@GoodByeSkyHarborLive]

Now what happens to long head of biceps after tenotomy? Can you contract it at all since they removed the tendon? Do you notice any weakness? ​@@FalconTypo3

[@yasim9435]

Great info. Thanks. I wonder what is the deficiencies of nonsurgical treatment for handling dynamic load . Are there tennis players who satisfied/dissatisfied with Nonoperative treatment ?

[@erickibarra5516]

Excellent explanation thank you

[@melissaknotts788]

I had a tenotomy and the cramping after surgery was horrible. I would ice my bicep to help with it. It lasted on and off for about 6 weeks.

[@GoodByeSkyHarborLive]

Did you notice any bicep weakness or size decrease when flexing how is it now?

[@melissaknotts788]

@@GoodByeSkyHarborLivethat arm feels like it’s weaker than the other arm. Most people say recovery takes about a year so maybe it will be better in April 2024 for me

[@m.bird.]

Spasming is super common. No idea why he is saying his patients never experience this. They probably just don't tell him.

[@hanimmanger1918]

Thanks you for sharing this with us

[@a.brucemcdonald9038]

“ONLY” an 11% decrease in strength!!!!! That’s HUGE. I’m 59 but very very active in fitness and strength training-including pull-ups that require great force production throughout the back, shoulder joint and biceps. Neither of these surgical options sound good to me. What options are there to retain FULL functionality? The tendon attaches to the socket to assist with shoulder flexion.

[@lukeskywalker7258]

Is thag for tenodesis or tenotomy?

[@terryadams1830]

@@lukeskywalker7258 The doc said the tenotomy (cutting the tendon and leaving it loose) results in about an 11% loss in strength. I don't believe the doc mentioned a loss of strength with the tenodesis (cutting the tendon and reattaching it at another location).

[@markz.5891]

None

[@shawnshurtz9147]

Yeah, none. You're almost 60. I'm 44 and just had a complete distal bicep rupture, and it was completely repaired into the bone, and I won't have full power or function anymore. I could have a 15 percent reduction in supination.

[@shawnshurtz9147]

I also forgot. Bicep is mostly used for supination of the hand anyway.

[@MIGGS32100]

Can the long head get loose if there is a complete distal bicep rupture and cause shoulder issues?

[@trinityacandhtg5543]

Great and helpful information 👍🙏

[@winston9505]

Informative. Thank you!

[@sgtrock2821]

I'm 60 years old and retired. I work out 6 days/wk with weights hard. Flat dumbrell presses are very painful to the front of my left shoulder to begin with then gets less painful after a few sets but still painful. Speeds test causes pain. It's been going on a week now. I train 6 days a week. 2 bdy parts/wk. Concentraion curls are pain free. Standing ez bar curls are painful to the front of the shoulder at the top of the curl. I curl strict. At the top the shoulder involves slightly and is paintful Skull crushers are also painful at about level of 5. Pushdowns no pain. Strange that I can do pushdowns with heavy weight but I'm gunshy to even try one push up. Any suspicions as to pathology? Thanks very much. Most informative I've found on this so far.

[@stever6105]

I just had the bicep tenodesis surgery that included a torn labrum/rotator cuff. 10 months ago I noticed pain in my shoulder when doing dumbbell presses. Close handed push ups and curls were no problem. Your symptoms were similar to mine. Find a good surgeon, as my first doctor was not well versed in bicep injuries.

[@FalconTypo3]

I realize this is 2 years ago, but if you get this: did you you have tenodesis or tenotomy?

[@LindaHaghgoo]

My orthodoc didn't bring up any longhead bicep tear in my swollen upper arm and just x-rayed for fracture of the proximal humeral head. Now it's been three months and the "popeye" just became evident with the reduction of swelling. What if the groove was messed up by the conservative healing of the fracture? I am 76 and will go for surgery if I can.

[@m.bird.]

Get an MRI with dye

[@sherrymire5969]

Excellent video. Thanks

[@yamaha1675]

I have a long head rupture from 3 months ago. Have I waited to long?

[@FairwayJack]

smart guy ... if the biceps supinates the forearm ... I wonder which muscle pronates the forearm? ... this is my problem and it is related to the tennis serve

[@m.bird.]

Pronator teres. But the long head bicep stabilizes or resists pronation eccentrically

[@theodorantal238]

I need your advice :) A week ago I was doing pec cable flies from slightly below shoulder level, lightweight (12 kg either side) really slowly, controlled, focusing on the stretch. I was allowing my arms to go back a lot at the end of the eccentric. And, third set, 12th rep, I heard a subtle pop. Accompanied by a strange sensation. Not pain, or very little pain. It was more like a sensation of ease. As if my right shoulder joint had found a better location and it could move more freely. I have always had limited mobility in my right shoulder accompanied by pain both on internal and external rotation limits. So yes - first I thought it was a “good pop”… But when it came to train the biceps, I realised a strange gap between my felt and the long head of my biceps. I could still contract it, but it felt out of place so I stopped. I also noticed a slight yellowing right under my front delt where my bicep used to start, but now there is a slight gap. Went to emergency room and was told it’s a tear but it would heal on its own. Dismissed in 10 minutes. Having replayed it in my mind, what I believe happened, was a shift of the upper tendon. It simply feels as if that long tendon no longer runs in the groove at the top of my humerus, instead it moved a couple of centimetres forward and internally. What do you think, And what should I do? I really want to keep my functionality of my body, you know… I’m quite worried. Theodor

[@m.bird.]

Get an MRI with dye

[@ErinM-2024]

My bicep has been hurting for 3 years. My mri shows my shoulder is fine but I just had a Ct arthrogram and it shows a superior labral tear. I have failed pt and injections. My surgeon says it’s time for surgery. I’m 43. He says for a young female I need the tenodesis.

[@VideoNash]

thanks

[@biosphere8488]

Is it fair to say that a spontaneous proximal bicep tear of the long head ultimately will have a similar prognosis that of a Biceps Tenotomy?

[@whywhenwhere4377]

Does the transverse humeral ligament not hold the tendon in place?

[@makkavelli3972]

So which opperation is the best??? I hurt my Biceps long tendon whilst boxing on heavy bags,,i doo more weights now than boxing but always pain in my sholder,which of the two opperations would be best??? Thanks

[@ozpain1]

What about for rock climbers in their early 40s??

[@carmenvella6596]

why my bisep is swollen what can i do please greetings from Malta

[@neilpye6089]

Can tendon tears affect blood flow around limb?

[@barbarawalsh4936]

Hello Dr. Adam. I am 61 years old, with a recent injury to the tendon that goes to the shoulder joint. It especially bothers me at night trying to get my arm positioned just right. Tonight as I am watching your video, if I move just right I get a pain going across the clavicle and up into the side of my neck. I don't know how bad this actually is, but it has bothered me for almost 2 weeks. I do not have any insurance and don't live close to a free clinic. I have tried some of the exercises recommended on other sites, but as soon as I start doing them the pain is intense, so I stop right away. I don't know if this is something serious and don't want to damage the tendon further. It is in my right shoulder and unfortunately, I am right-handed so all the lifting I do is done on that side. Any suggestions, please??

[@patientzero5685]

I know it’s been a year, but I hope your shoulder is better!

[@Tooclosetothetruth]

I have the same sort of issue but the pain I get is horrific. I first injured myself overseas and my shoulder took at least three years just for the pain to go. This was about 15 years ago and it has gone three or four times since and each time it has taken at least a year for the pain to go. I recently went to A&E and was sent to a physio. I also have a huge swelling above my clavicle although the swelling is painless. I was told to do some light exercises and referred to a specialist. Worst advice ever being told to do light exercises as it has just got worse and prolonged the pain. The pain goes down my arm, accross my clavicle and into my neck and my jaw. The pain deep inside my shoulder front and back is horrendous. I have had to stop playing guitar, cycling and I am also off work. Regardless what the physio says, it only gets better after a very lengthy rest. Using the arm at all knocks it's recovery back each time and that is just simple tasks. I am a man who can deal with pain but this is off the scale.

[@nykko73]

@@Tooclosetothetruth hi there I have a similar situation here , 2 weeks ago I was doing some bench press at the gym but prior that I had some light pain in my left shoulder anyway after pushing hard on that bench I felt that the pain in the shoulder is getting worse and next day more painful, the worst is in the night I can’t find a comfortable position to be able to sleep without feeling the pain, now the pain is in my left shoulder , going in the bicep and fingers is like my left hand is weak and having this weird feeling …I might have to get an MRI to see what’s the real problem, I scared of surgery I am a crane driver and I want my both hands fully functional 😢

[@3.0colorado21]

This was helpful. My shoulder has been so annoying to deal with. I tore a lot of stuff and workmens comp was ignorant at best and now a couple years later I had a bunch done and a labrum repair but now I guess my bicep is detaching. I have several concerns because I am young and have a lot of heavy stuff to do in life.

[@HeyIntegrity]

Slap tear?

[@3.0colorado21]

@@HeyIntegrity that was one, yes. I just had the bicep reattached and while he was in there he cleaned up my ac joint. I can’t wait to start physical therapy and put this mess behind me.

[@HeyIntegrity]

@@3.0colorado21 okay so I'm guessing biceps tenetomy and they removed/cleaned up the slap and ac joint? Did you have the surgery years later?

[@3.0colorado21]

@@HeyIntegrity correct. Original injury was February 2018, first surgical repair was march 2021. And then the most recent being a few days ago.

[@HeyIntegrity]

@@3.0colorado21 thanks. Did they mention any attempt at repairing the slap? I'm asking because I have a chronic slap tear and considering surgery too. I want to know if surgeons are still willing to repair or people have it had it repaired after so long but it seems most of the time they just remove it and do the biceps tenotomy. Did you notice any bicep weakness during heavy lifting after the tenotomy?

[@emmanuelmunoz2528]

So I guess I can't do shoulder presses anymore 😕 😔 it hurts when I do

[@dudealbert11]

I was diagnosed with a high grade partial proximal bicep tear . As a 23 yr old amateur mma fighter , should I consider surgery? As It not really painful but it’s affecting me mentally since im not sure what to expect. If it fully tears will it be a different surgery?

[@HeyIntegrity]

Hey what was the pain level and symptoms? Mine seems similar story to yours but never went to doctor. It doesn't bother me much anymore. Just tightness and some soreness in biceps.

[@glasssteel6306]

darn injuries such. traumatic injuries suck alot more

[@davidolsen9098]

I just had that surgery 3 weeks ago. My bicep pulled out of the anchor point 2 days ago and now have popeye arm. I am getting that fixed. Can you let me know what I can expect?

[@FalconTypo3]

I realize this is a year ago: did you get your "Popeye arm" fixed? If so, what was the procedure, and how is it going? Thanks!

[@davidolsen9098]

No , the Doctor said it had been out of place to long so now I do not have the strength in the arm I once had.

[@FalconTypo3]

@@davidolsen9098 I am so sorry to hear this-- and is why I am against snipping any tendons. I would rather have the 100% strength, full use of the bicep, and some pain in my shoulder (that can be managed/will improve over time).

[@royturnwall6467]

Im looking for an expert in this field located in the Inland Empire, San Diego or Los Angeles area of California.

[@binadhakan6023]

Hello pls see my reports 1) Mild supraspinatus and infraspinatus insertional tendinosis with subtle bursal surface fraying. Mild to moderate subacromial bursal fluid and edema. The subacromial bursitis is disproportionate to tendon changes and correlation with inflammatory markers/recent subacromial bursal injection is recommend. 2) Nearfullthicknessbicepstendontearfromitsglenoidattachmentretractedinferiorto the bicipital groove by approximately 4.5 cm. 3) Moderate rotator interval scarring with mild inferior capsular thickening and edema mostly suggests adhesive capsulitis and needs clinical confirmation. As compared to previous MRI dated 18-01-2022, bursitis is a recent finding. The biceps tear is also an interval development. The changes of capsulitis are grossly unchanged.

[@HeyIntegrity]

What did you do between those two scans that you think injured the biceps? I'm also curious what acrivities/sports you do and what have you been taking for pain?

[@HeyIntegrity]

Also your report is very detailed. Which doctor ordered and which imaging center did you get it from?

[@davidolsen9098]

My doctor had me out of the sling after the first week and right into therapy. Sounds like it was a bad idea eh?

[@tgojenola8217]

My doctor did the same but he waited two years before he sent me to therapy, the therapist is the one that told me that I had torn it like I had suspected and asked me if I had bled inside my arm alot back when it had happened and what it had looked like. (Popeye) and sent me back to my doctor for an MRI he said if he kept treating me he could damage it worse.

[@tonyorob]

Something happened with my long head tendon while holding it in the flexed position while waiting for my girl friend to focus her camera to take a pic. I felt a very slight 'pop' but no pain at all. I now have the Popeye-effect and still no pain, swelling, bruising or discomfort...Do you think I ruptured the tendon or is it that the tendon just slipped out of the bone groove?

[@tushar5947]

Did u get the solution as I have same problem like u

[@tonyorob]

@@tushar5947 No I didn't

[@mlinger18]

I tore my long head tendon a month ago ,the mri and X-rays showed it tore from shoulder but I have a popeye bicep now.. the dr said I don’t need surgery my question is how long do I need to let it heal before I can lift weights again ??

[@Ivriss]

Following

[@mlinger18]

@@Ivriss I can’t get any answers ,so fuck it I’m lifting

[@Ivriss]

@@mlinger18 My concern is if I don’t get the surgery will the biceps still grow when lifting. Or will the bicep not grow either way. 🤷

[@mlinger18]

@@Ivriss mine is a proximal long head tear which u don’t need surgery ,but it will never reattach.. if u have a distal short head tear you need surgery within 3 weeks.

[@mlinger18]

@@Ivriss if it’s the longhead yes it will grow but will be shorter looking .. mine right now because of the injury has a really nice peak that I never had before.. go get a mri done and see what type yours is.

[@tpike32]

Umm.. the short head does not go around the infraspinatus 😂 it attaches to the front near the pectoral muscle . You should of turned model around

[@likoltarypv4478]

Ok doctor pike32

[@jovandias3807]

Can frozen shoulder cause pain in bicep tendon.

[@jkearns2569]

Absolutely. I'm being treated for that myself. Very painful. PT for the past five weeks and very painful at night and in the morning.

[@dr.adamderhakeqmgorthopedi4730]

A frozen shoulder can be very painful. I consider the pain secondary to the stiffness until proven otherwise. I recommend that my frozen shoulder patients get all of their motion back first, then examine for any other sources of pain.

[@jovandias3807]

@@jkearns2569 so you also have pain in longhead bicep tendon .I'm working on range of motion but bicep tendon hurts preventing me from getting better range of motion .

[@HeyIntegrity]

@@dr.adamderhakeqmgorthopedi4730 hey can you assess a decrease in capsular volume by shoulder mri without contrast?

[@garrettfitzgibbons2501]

@@dr.adamderhakeqmgorthopedi4730 Thanks for informative video re: biceps options (just had my TSA with subpectoral tenodesis) As a PT, I always tell my frozen shoulder patients that they should experience decreased pain concurrent with ROM gains, but there may or may not be underlying pathology that needs to be addressed when we max out...

[@michaelbaney6610]

Looks painful 😕

[@kimsunku07]

4:50

[@meh11235]

Interesting... No real fix.

[@springteen3743]

Practically the only benefit of the surgery is to alleviate pain but for functionality not much progress 😢

[@litsci1877]

omg came here for info, get smacked with more ortho bro by and for sports bro types. TALK TO THE REST OF US TOO. Jesus. Talk to women. Talk to nonathletes. Talk to older people. FORGET YOUR SPORTS BRO IDENTITY, ORTHO IS NOT ALL ABOUT YOU.

[@kennethmarotte5861]

THANK YOU FOR THE WELL INFORMED VIDEO . I HAVE BEEN TRYING TO FIND A DR WHO DOES THIS OPERATION OR REPAIR IN FL I LIVE IN SANFORD FL 32773, IS IT POSSIBLE TO GUILD ME A DR IN MY AREA WHO DOES THESE REPAIRS . RTHANK YOU SO MUCH.

[@alfonsoperez8535]

you should just open a university and tech everythi g yourself you afe great at explaining wow!