Lesions of the long head of the biceps tendon

Lesions of the long head of the biceps tendon are generally a component of a diffuse degenerative process involving the subacromial space including the rotator cuff, bursa, biceps tendon, and possibly the acromioclavicular joint. As such, surgical approaches should be designed to treat each component not restricting the surgery to a biceps tenodesis. On occasion bony injury directly to the bicipital groove may result in an inflammatory process in the tendon or even dislocation of the tendon if there was damage to the lesser tuberosity and subscapularis tendon. In these patients biceps tenodesis and coracoacromial ligament excision is advised. The entity of a "subluxating biceps tendon" without damage to the lesser tuberosity or subscapularis is a diagnosis that we are unable to reliably arrive at. It appears that most patients with biceps instability have combined tuberosity or rotator cuff injury allowing the tendon to migrate medially. Ruptures of the long head of the biceps are generally associated with rotator cuff disease, but a localized process secondary to trauma or injections may account for some ruptures. Nearly all are managed conservatively, but the patient is followed closely and forewarned regarding possible rotator cuff degeneration. In young patients a more aggressive approach including shoulder arthrography and early repair, if a cuff tear is noticed, would be recommended if one would hopefully arrest the degenerative process.