Long Head of Biceps Tendinopathy & SLAP Tear (Superior Labrum Anterior to Posterior)

What is the Long-Head-Of-Biceps-Tendon and tendinopathy?

The biceps muscle is the large bulk at the front of the upper arm. It has two muscle bellies and the larger of the two has a long skinny tendon that runs up the arm close to the ‘humerus’ (bone of the upper arm) inside a bony groove. It then makes a turn towards the body midline and pierces through the joint capsule. It has it’s origin inside the shoulder joint at the top of the socket. Due to it’s complex arrangement the biceps tendon is prone to develop inflammation and degenerative changes.

What is a SLAP tear?

SLAP stands for Superior Labrum Anterior to Posterior. This basically describes the anchor of the long head of biceps tendon inside the shoulder joint at the top of the shoulder socket. It blends in with the labrum which is a circumferential cartilage structure around the socket. Damage to this area is called SLAP tear.

What are the symptoms of biceps tendinopathy and SLAP tear?

Patients with SLAP tear find it difficult to work above shoulder level. Any lifting, pushing and pulling can elicit pain and causes early fatigue. There might also be a radiating ache running down the front of the shoulder. A chronic ache wich gets worse at night are also characteristic.

Who will get biceps tendinopathy and SLAP tear?

SLAP tears and biceps tendinopathy occur due to wear and tear or acute trauma. The traumatic event is often an unexpected traction or levering force to the shoulder.

Treatment of biceps tendinopathy and SLAP tear

Milder cases of tendinopathy can be treated with physiotherapy and cortisone injection. Higher grade SLAP tears continue to generate pain and might require surgery. This also applies for persistent cases of symptomatic tendinopathy.

Surgery for biceps tendinopathy and SLAP tear

The surgery will be performed via arthroscopy (keyhole surgery). Some SLAP tears in a younger population below 35 years of age can be successfully repaired. I patients above 35 years these procedures often fail and a so called ‘biceps tenodesis’ is performed. This means the tendon will be anchored in the humerus outside the actual joint and the portion inside the joint will be removed. This way the biceps muscle retains its normal shape and function and the pain generating structure has been taken away. These procedures most often can be performed as day surgery.

Preparing for biceps tendinopathy and SLAP tear surgery

Prior to the procedure, we will arrange for one preconditioning physiotherapy session where we fit a shoulder immobiliser, explain some simple exercises and give you an ice bladder with icing instructions. If required we will also arrange for a bulk billed pre-admission clinic at the hospital. This is run by a specialist anaesthetist who will gather information and request investigations that are required for safe anaesthesia. Our reception staff will advise of costs, hospital and admission details.

Recovery after biceps tendinopathy and SLAP tear surgery

Following the procedure the arm will be placed in a shoulder immobiliser for roughly two weeks. Physiotherapy will aim for comfort and avoiding joint stiffness. A review with the treating surgeon will be scheduled at the two and six week mark after surgery. Whilst light activities of daily living can be resumed after a few days, heavy lifting should be avoided for about eight weeks.

Biceps Tendon Rupture Video