Proximal biceps tendon injuries refer to biceps injuries at the level of the shoulder and usually affect the long head biceps tendon. They comprise strains, partial and complete tears.
On this page:
Epidemiology
Proximal biceps tendon injuries account for about 96% of all biceps injuries 1.
Risk factors
Conditions that account as predisposing factors for proximal biceps tendon injuries include the following:
advanced age
overhead activity
corticosteroid use
smoking
Associations
Proximal biceps tendon injuries are associated with other shoulder pathologies including:
Diagnosis
The diagnosis of a proximal biceps tendon rupture can be established by a combination of clinical features and characteristic imaging findings.
Clinical presentation
Proximal biceps tendon injury is a common source of shoulder pain 1,2. Tendon rupture additionally results in elbow flexion and/or forearm supination weakness and might result in a characteristic ‘Popeye deformity’ with the muscle retracting and moving caudally 1.
Pathology
The biarticular configuration and the high amount of fast-twitch (type II) muscle fibers of the biceps muscle are considered risk factors for biceps injury. The long head biceps tendon is most frequently affected by far 2.
Location
The most common sites of proximal biceps tendon injury are 1:
tendon origin at the superior glenoid labrum
the musculotendinous junction at the exit of the bicipital groove
Radiographic features
MRI
Features that can help diagnose proximal biceps tendon ruptures include:
absence of the tendon or tendon retraction
fluid-filled tendon sheath
muscle edema: non-specific
muscle atrophy: non-specific
Treatment and prognosis
Surgical treatment includes biceps tendon tenotomy or tenodesis.