SHOULDER ARTHROSCOPY

Q:A:I ruptured the biceps

tendon in my shoulder. I was told surgery was not necessary. Is that true? You were given good advice, as most ruptures of the biceps tendon near the shoulder leave patients with few if any symptoms within a matter of weeks. The portion of the biceps muscle-tendon unit that resides in the shoulder is referred to as the proximal biceps tendon or long head biceps tendon and it is frequently torn in middleage or older patients, most often males, typically after a lifting maneuver. The tendon will begin to fray like an old piece of rope or shoelace with age, leading to the eventual failure.

What confounds patients is how normal their arm function remains after such an injury, as they view the biceps muscle as a powerful lifting force in their upper arm. It turns out that there exists a fair amount of redundancy in this area and two other muscles, the brachialis and brachioradialis, provide more than enough flexing power for our functional needs, including heavier lifting. Some patients may appreciate a small loss (less than 10%) in strength, but the vast majority cannot detect any difference in their arm function after the injury. Many patients will also report that they had experienced pain in the front of their shoulder before the injury, a result of tension felt through the frayed, partially torn tendon. After a brief period of bruising and swelling, this pain will reliably disappear once the tendon gives way, as the tension through the tendon is relieved.

What is most noticeable, however, is the cosmetic change in the area of the biceps muscle, which contracts and becomes more prominent, referred to as the “Popeye” muscle. While most

patients are unbothered by this, some may seek a surgical solution if they are unsatisfied with how their arm appears. There can be some minor cramping in the biceps muscle with prolonged lifting moves which also rarely presents problems but in theory could be another reason to consider surgery.

As all surgery involves inherent risk of complication and the overall benefit to the patient of surgical intervention for this injury is minimal, as detailed

above, seldom is there a patient with a rupture of the proximal biceps tendon near the shoulder that should be managed with surgery. A short course of simple pain relievers and perhaps a few visits to a physical therapist will

predictably lead to high levels of satisfaction after this injury.

To learn more about the biceps tendon and other shoulder conditions visit ohioshouldercenter.com.

Eric M. Parsons, M.D.

Ohio Shoulder Center for Arthroscopy Lake Orthopaedic

Associates, Inc. 36060 Euclid Ave., Suite 104

Willoughby 440-942-1050 9500 Mentor Ave., Suite 210

Mentor 440-352-1711 www.ohioshouldercenter.com