The biceps is a tendon that splits into two parts at the level of the shoulder. It is unusual for a tendon, as one part of it (the long head of biceps) is found right within the shoulder joint. This unfortunately makes this part of the tendon susceptible to being damaged after an acute injury or after wear and tear of the shoulder joint. This can usually be diagnosed with a specialist shoulder examination, but may also require an ultrasound or MRI scan to confirm the diagnosis. Occasionally an ultrasound guided steroid injection (click for more information) will be used to give pain relief and help with the diagnosis.
If the biceps tendon is damaged after an acute injury, the tendon tears away from the shoulder joint at the point at which it attaches to the socket. If this is causing pain, a small day-case keyhole operation may be considered. The long head of biceps can be reattached to the socket with metal anchors that sit in the bone and the sutures that are attached to the anchor tie through the tendon. This is called a Superior Labral Anterior-Posterior (SLAP) repair (click for more information on rehabilitation).
Occasionally, the tear is not capable of being repaired successfully, in which case the tendon is completely released and reattached to the bone of the ball of the shoulder joint, but outside the joint. This can give good pain relief and does not affect the function of the biceps. This is called a biceps tenodesis (click for more information on rehabilitation).
If the tendon is worn out rather that torn by an injury and is painful, a keyhole operation can be considered. This may be part of another keyhole operation or it can be carried out on its own. In this procedure, the long head of the biceps is released within the joint, but the other part of the tendon is left alone. This is called an arthroscopic biceps tenotomy and can give good pain relief. It does change the shape of the biceps on the front of the upper arm, but rarely causes any noticeable difference in strength.