The long head of biceps tendon runs in a groove at the front of the shoulder (bicipital groove). The tendon can become inflamed and damaged, either through overuse (weightlifting and overhead sports) or simply with time.
What are the symptoms?
The patient usually complains of a pain in the front of the shoulder followed by a popping feeling. There is then a characteristic deformity seen in the biceps muscle. This is the so called “Popeye Sign”, in which the muscle belly appears to move towards the elbow as the elbow is flexed. The pre-existing pain often settles rapidly.
In the older patient, there is often no residual problem apart from a cosmetic deformity. The younger patient may complain of aching and pulling in the upper arm, particularly as the elbow is flexed.
How is the diagnosis made?
The doctor will take a full history and examine the shoulder and arm. In most cases no further investigation is necessary. Occasionally, if there is concern about the rotator cuff tendons, an MRI scan may be arranged to assess them.
What is the initial treatment?
The initial treatment is symptomatic and includes rest and anti-inflammatories. In the older patient, the discomfort usually settles within a few weeks and there are no residual problems apart from a cosmetic deformity, the “Popeye Sign”.
If initial treatment does not work, what is next?
The younger patients may complain of a persistent ache in the front of the arm, made worse by lifting or carrying. If the symptoms are intrusive enough then surgery may be needed.