Biceps Tendon Subluxation

Tendons attach muscle to bone. The bicep muscles (the muscles that flex the forearm at the elbow joint and assist in flexing the arm at the shoulder joint) have three tendons. One tendon attaches at the elbow and the other two at the shoulder. One of the tendons that attaches at the shoulder (the long head) runs through a groove in the bone before it enters the shoulder joint. The groove is covered by the transverse humeral ligament, which helps keep the biceps tendon in the groove. Bicep tendon subluxation occurs when the tendon moves in and out of this groove. Bicep tendon subluxation usually occurs in the presence of another shoulder condition such as a tear of the subscapularis tendon (a tendon of one of the rotator cuff muscles).

SYMPTOMS

  • Presence of a "clunking" feeling when the arm is rotated outward passively or inwardly against resistance.

  • Pain and tenderness in the front of the shoulder.

  • Pain that increases with shoulder and elbow motion such as bending the elbow and turning ones palm upwards against resistance.

  • A crackling sound (crepitation) when the shoulder is moved.

CAUSES

Injury to the rotator cuff, either traumatic or degenerative.

RISK INCREASES WITH:

  • Contact sports, throwing sports, weightlifting, and bodybuilding.

  • Heavy labor especially involving lifting.

  • Poor strength and flexibility.

  • Failure to warm-up properly before practice or play.

PREVENTION

  • Appropriately warm up and stretch before practice or competition.

  • Allow time for rest and recovery.

  • Maintain appropriate conditioning:

  • Shoulder and elbow flexibility.

  • Muscle strength and endurance.

  • Cardiovascular fitness.

  • Learn and use proper technique, especially in throwing sports.

PROGNOSIS

Surgical repair of the rotator cuff with repair of the transverse ligament typically reinstates full stability of the biceps tendon.

RELATED COMPLICATIONS

  • If activity is begun too early.

  • Recurrent symptoms.

  • Prolonged healing time.

  • Persistent subluxation with shoulder and elbow function.

  • Weakness of elbow bending and forearm rotation.

  • Prolonged disability (uncommon).

  • Shoulder pain.

  • Stiffness or loss of motion of the shoulder.

TREATMENT

Initially, pain should be managed with non-prescription medication and ice. Individuals should begin stretching exercises and learn proper technique for the activity that caused the injury. The exercises may be conducted at home or under the supervision of a physical therapist. Typically surgical repair of the rotator cuff and reconstruction of the transverse humeral ligament are recommended. On occasion, cutting of the bicep tendon and stitching (suturing) it to the bone of the upper arm (tenodesis) may be performed.

MEDICATION

  • If pain medication is necessary, nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers are usually only prescribed after surgery. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 4 to 6 weeks despite treatment.

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).