A Common Cause of Shoulder Pain: Biceps Tendon Injuries

What many athletes with shoulder pain don’t realize is that shoulder pain can be secondary to lesions or tears of the biceps tendon in the shoulder. Yes, that is correct, the biceps muscle turns into a tendon and inserts into the shoulder on the socket side. Tears of the biceps tendon at this insertion on the socket are known as labral tears. Labral tears can be “superior” (on the top of the socket), and are common among throwing athletes, but they can also occur from falls onto an outstretched arm.

Anatomy and Mechanics

When the shoulder dislocates, the labrum on the front of the socket can tear, which is referred to as a Bankart lesion. The biceps tendon, just before entering into the shoulder, runs in the bicipital groove located in the humeral head. Tissue supporting the biceps in this groove runs over the top of the groove. This forms the “pulley.” The pulley holds the biceps in this groove and is made from fibers of the coracohumeral ligament. pulleyOn the posterolateral side of the groove, fibers from the supraspinatus rotator cuff tendon also contribute. Fibers from the subscapularis rotator cuff tendon contribute to the anteromedial side of the pulley.

Saving the Biceps Tendon with shoulder surgery

Since 1995, Dr. William Bennett, founder of Bennett Orthopedics and Sportsmedicine, has treated lesions that involved both sides of the pulley, salvaging the Biceps tendon. Most surgeons choose to resect (cut) the tendon, tying it into the bone. This removes the tendon from its natural travels across the shoulder joint. Dr. Bennett differs from many other orthopedic surgeons in that he has successfully repaired, arthroscopically, all of these lesions. Dr. Bennett’s special expertise in this area allows him to save the biceps tendon. You can reference Dr. Bennett’s pioneering studies on this type of procedure here:

Arthroscopic Bicipital Sheath Repair: Two-year Follow-up with Pulley Lesions, Arthroscopy 2004.

In 2005, Dr. Bennett joined a prestigious panel of shoulder surgeons at Wes Nottage’s Shoulder Controversy seminar in New Port Beach, California. Chiefs of shoulder services from Harvard, clinics in France, Italy, San Antonio, and San Francisco were presenters. Dr. Bennett presented his experience with repair of the biceps pulley. While most still cut the tendon, Dr. Bennett presented evidence to preserve the biceps tendon. He noted that overhead athletes, especially baseball pitchers, rely on knowing where their arm is in space. There are nerves around the biceps tendon that help tell the athlete’s brain where the arm is in space. To this day, Dr. Bennett maintains that in most situations, the biceps should be preserved. Famous surgeon Giovanni DiGiacomo of Italy concurs that the proprioceptive nerves around the biceps tendon may help the overhead motions of athletes.

Call (941) 404-2703 to schedule a consultation with Dr. Bennett to determine the best treatment for your shoulder pain or submit our online form.