Long Head of the Biceps Tendon Ruptures: Biomechanics, Clinical Ramifications, and Management

Pathology of the long head of the biceps tendon is a common source of shoulder pain and often occurs in combination with other shoulder disorders.

Nonsurgical management, including rest and activity modification, use of nonsteroidal anti-inflammatory drugs, physical therapy, and corticosteroid injections, is usually the first line of treatment.

Patients with symptoms that are refractory to nonsurgical management are indicated for biceps tenotomy or various tenodesis procedures.

Although several studies have reported a higher incidence of "Popeye" deformity, muscle cramping, and pain in the bicipital groove postoperatively with tenotomy compared with tenodesis, there are no substantial differences in functional scores or patient satisfaction between the 2 techniques.

To date, both tenotomy and tenodesis have been shown to be effective options in the management of long head of the biceps tendinopathy, and there are advantages to each procedure.