Evaluation and treatment of biceps tendon pathology

Until recently, the role of the long head of the biceps tendon as a source of shoulder pain had been controversial. With careful examination, improved imaging techniques, and arthroscopy, a specific diagnosis can be made. In 95% of patients, biceps tendinitis is secondary to a primary diagnosis of impingement syndrome. Subluxation of the biceps tendon and primary biceps tendinitis are diagnoses of exclusion. However, in the properly selected patient, both respond well to biceps tenodesis. Rupture of the long head of the biceps tendon can be the end result of any of these pathologic processes. In the older sedate patient, conservative treatment results in little functional loss and a mild cosmetic deformity. In the young active patient, especially those who perform tasks that require supination strength, a primary biceps tenodesis should be performed, as well as decompression if there is any evidence of impingement. The key to successful treatment of lesions of the long head of the biceps tendon is recognition of associated pathologic findings in the shoulder. With advances in arthroscopy, the orthopedist can tailor treatment exactly to the pathology, minimizing morbidity and maximizing a successful outcome.