What are Long Head of Biceps (LHB) tears?
The biceps is a muscle with originates from two places in the shoulder, one of which is above the shoulder socket and the other is part of the shoulder blade called the coracoid process. The main function of the biceps is in the supination of the forearm but it also assists with flexion of the elbow. Biceps injuries in the shoulder predominantly affect the long head of the biceps (LHB), with pain and degenerative changes, and in some cases acute rupture.
What are the symptoms of an LHB tear?
The main symptoms are characterised by pain affecting the anterior shoulder. Patients struggle with overhead activities and loading, including racquet sports and contact sports. Acute ruptures can lead to a classic deformity with the biceps retracting and bulging or dropping. This can be painless but patients can complain of cramping.
How are LHB tears diagnosed?
It is diagnosed by taking a careful history and performing a detailed examination. Ultrasound and MRI can also be used to assess for tears and tendinopathy and to exclude associated injuries such as rotator cuff injury or SLAP tear, where the biceps is destabilised with an additional shoulder injury.
How are LHB tears treated?
Treatment begins with symptomatic management including pain killers and activity modification. The functional demands of the patient, including their chosen sports and occupation will help to guide treatment options.
Ultrasound-guided injections can be helpful both diagnostically and therapeutically.
Operative treatment will be guided by severity, patient preferences and symptoms. Open or arthroscopic procedures performed as a day case procedure are used to either release the tendon ‘a tenotomy’ or to remove the pain generating damaged tendon and reattach the tendon ‘tenodesis’.
These operations can lead to an earlier return to sports and normal daily activities.