STAMFORD, Conn. -- Cartoons depicting Popeye’s bulging biceps after he guzzled down a can of spinach only told half the story. Unfortunately, America's favorite sailor, like many others, went on to develop intense pain in the front of his shoulders as the years passed and was diagnosed with biceps tendinitis.
Biceps tendinitis is a catchall term that describes pain related to the long head of the biceps tendon, or LHBT, which stems from a wide array of different lesions. Recent research has helped us expand our understanding of this important disease. Below HSS sports medicine surgeon Dr. Samuel Taylor answers your questions about bicep pain.
Does MRI always show biceps disease?
No. Recently we compared MRI reports with surgical findings from a large group of patients undergoing shoulder surgery and found that, when present, lesions were often not recognized by MRI.
Does arthroscopy always show biceps disease?
Not necessarily. In our study just published in Arthroscopy Journal, HSS doctors showed that only 55 percent of the LHBT could actually be seen during routine shoulder surgery and that 45 percent of 277 patients with chronic biceps-related pain had hidden lesions.
Is physical examination still important?
HSS' Dr. Stephen O’Brien devised a series of physical examination maneuvers called the 3-Pack that have been shown to be the most effective tool available for diagnosing biceps disease when present.
What are nonsurgical treatment options?
Biceps tendinitis is incredibly common, and fortunately the vast majority of people get better without surgery. Anti-inflammatory medications by mouth, changing your activities to avoid movements that produce pain and structured physical therapy are the most useful first line treatment.
What are surgical treatment options?
In a small subset of patients, surgery may provide the best opportunity for recovery of function and alleviation of pain. Treatment options include tenotomy, in which a surgeon cuts the LHBT, thereby relieving painful tension on the tendon, or tenodesis/transfer, where a surgeon cuts the LHBT and moves it to another location.
Dr. Samuel Taylor is a sports medicine surgeon at Hospital for Special Surgery, specializing in minimally invasive and reconstructive techniques of the shoulder, elbow, and knee. He practices in both the HSS Outpatient Center in Stamford and the hospital’s main campus in New York.