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.

If you or someone you know has suffered an injury or is experiencing pain in their shoulder or difficulty with moving the shoulder, arm or elbow and would like a consultant-led review, please contact us. Grosvenor Orthopaedics have extensive experience in the treatment of ACJ injuries with excellent patient outcomes.


Grosvenor Orthopaedics have extensive experience in the treatment of should & elbow -related injuries with excellent patient outcomes.


If you would like to learn about other shoulder & elbow conditions click the button below to find out more


If you would like to learn about other shoulder & elbow treatments click the button below to find out more

our specialist shoulder and elbow consultants

Shoulder and Elbow care at Grosvenor Orthopaedics is led by our consultant surgeons Mr W James White and Mr David Butt, both graduates of London medical colleges. They bring extensive experience to Grosvenor Orthopaedics having worked across Guys NHS Trust and the world renowned Royal National Orthopaedic Hospital.

Our team have broad experience in the successful treatment of a range of shoulder and elbow problems, addressing both young and sports related injuries as well as those relating to trauma, disease process and genetics.

Patients who choose Grosvenor Orthopaedic Partners for their treatment will receive some of the best care available in the UK. Our team are leading consultants across London’s shoulder and elbow clinics and offer specialist care to our private patients through King Edward’s Hospital, HCA Lister and other major private hospitals in central London.

Our team are well placed to manage and treat a diverse range of shoulder and elbow problems utilising cutting edge diagnostic technology and treatment approaches, both surgical and conservative. Below is an overview of some of the conditions we treat but for a more thorough understanding please contact our team here


Consultant Shoulder and Elbow Surgeon

FRCS(Tr&Orth), MBBS, BSc(Hons)
James is a Consultant Shoulder and Elbow Surgeon, practising at Guy’s and St Thomas’ Hospital NHS Foundation Trust, King Edward VII’s, The Lister Hospital Chelsea and HCA Chiswick Outpatient Clinic. His practice encompasses all aspects of shoulder and elbow surgery including arthroscopy, arthroplasty and trauma. He has a reputation as a thorough clinician, effective communicator and skilled surgeon. Through joint decision-making with the patient and utilising non-operative techniques where possible, he achieves the best possible outcomes for patients. When surgery is required, James has excellent outcomes based on his precise and prepared approach to operating.


Consultant Shoulder and Elbow Surgeon

FRCS(Tr&Orth), MSc, MBBS, BSc(Hons)
David is a Consultant Shoulder and Elbow Surgeon, practising at the world-renowned Royal National Orthopaedic Hospital Stanmore, King Edward VII’s Hospital and One Hatfield. His practice involves all aspects of shoulder and elbow surgery, from minor injuries to complex reconstructive procedures. He strongly believes in shared decision making and a patient-centred approach to treatment. He is a meticulous surgeon using up to date and evidence-based techniques to treat every patient’s individual needs.

What some of our patients say

Mrs JS

Thank you to the whole team for getting me back on my feet again