What is a SLAP tear and how is it related to biceps tendinopathy?

A SLAP (superior labrum anterior to posterior) tear is a tear of the superior glenoid labrum at the point where the long head of biceps tendon attaches. SLAP tears cause anterior shoulder pain, clicking and frequently coexist with LHB tendinopathy. They are common in overhead athletes and can result from acute trauma or repetitive overhead loading. Treatment ranges from rehabilitation to arthroscopic repair, depending on severity.

What happens if the long head of biceps tendon ruptures?

Spontaneous rupture of the long head of biceps tendon, most common in middle-aged and older adults, produces a characteristic 'Popeye' deformity as the biceps muscle belly retracts towards the elbow. Pain often paradoxically improves following rupture. In older or less active patients, non-operative management with rehabilitation is typically recommended. In younger, active patients, surgical biceps tenodesis may be considered to restore upper limb strength.

What is the difference between biceps tenotomy and tenodesis?

Biceps tenotomy involves simply cutting the long head of biceps tendon from its origin, allowing it to fall towards the elbow and relieving the source of pain. It produces the 'Popeye' deformity in approximately 40% of patients. Biceps tenodesis involves detaching and reattaching the tendon to the upper humerus, preserving its length and the normal contour of the arm. Tenodesis is generally preferred in younger or more active patients, while tenotomy suits older or less demanding patients.

Can I exercise with biceps tendinopathy?

Yes, with appropriate modification. Heavy overhead lifting, pull-up movements and exercises involving strong elbow bending under load should be modified or avoided initially. Ms Razo will advise on which activities to continue, modify and avoid at each stage of rehabilitation.

Shoulder Conditions

Biceps Tendinopathy

Overview

What is Biceps Tendinopathy?

The biceps muscle has two heads, the long head (LHB) and the short head, which originate at different points on the shoulder. This anatomical course of the LHB tendon makes it particularly vulnerable to degeneration, inflammation and injury.

Biceps tendinopathy at the shoulder frequently occurs alongside rotator cuff pathology or SLAP (superior labrum anterior to posterior) tears. Specialist Hand Therapy is effective for tendinopathy and is essential following surgical biceps tenodesis or tenotomy.

Causes

What causes Biceps Tendinopathy?

Repetitive overhead activities: swimming, throwing, racquet sports and manual work
Coexisting rotator cuff tendinopathy: LHB tendinopathy rarely occurs in isolation
SLAP lesions: tears of the superior labrum at the biceps anchor
Instability of the LHB tendon
Sudden overload: a forceful lifting or catching movement
Age-related tendon degeneration in middle-aged and older adults

Symptoms

Signs & symptoms

Anterior shoulder pain, in the front of the shoulder and upper arm
Pain provoked by overhead lifting, reaching and carrying
Tenderness when touching the front of the shoulder
Weakness of elbow bending and forearm rotation

Treatment

How Hand Therapy can help

Ms Razo provides specialist assessment and evidence-based treatment for Biceps Tendinopathy. Following a thorough initial assessment, a personalised treatment plan will be developed to address your specific needs and goals.

Progressive Rehabilitation Programme

A graded exercise programme drives tendon adaptation and remodelling. Ms Razo designs the programme to match the tendon's current load capacity and progresses it systematically as symptoms improve.

Shoulder Biomechanical Retraining

Because LHB tendinopathy almost always coexists with rotator cuff pathology and altered shoulder mechanics, Ms Razo addresses these contributing factors alongside the biceps tendon itself. Comprehensive treatment of all pathologies are integrated into the rehabilitation programme.

Post-Injection Rehabilitation

Ultrasound-guided corticosteroid injection into the bicipital groove may be used to manage acute tendon pain. Ms Razo provides structured rehabilitation following injection to address the underlying biomechanical drivers and progressively reload the tendon.

Post-Surgical Rehabilitation

Biceps tenotomy (dividing the LHB tendon) and biceps tenodesis (reattaching it to the upper humerus) are common surgical procedures for LHB tendinopathy or rupture. Ms Razo provides specialist post-operative rehabilitation following both procedures. Intervetnions address scar management, progressive loading and functional restoration shoulder and elbow function.

FAQ

Frequently asked questions

: A SLAP (superior labrum anterior to posterior) tear is a tear of the superior glenoid labrum at the point where the long head of biceps tendon attaches. SLAP tears cause anterior shoulder pain, clicking and frequently coexist with LHB tendinopathy. They are common in overhead athletes and can result from acute trauma or repetitive overhead loading. Treatment ranges from rehabilitation to arthroscopic repair, depending on severity.
: Spontaneous rupture of the long head of biceps tendon, most common in middle-aged and older adults, produces a characteristic 'Popeye' deformity as the biceps muscle belly retracts towards the elbow. Pain often paradoxically improves following rupture. In older or less active patients, non-operative management with rehabilitation is typically recommended. In younger, active patients, surgical biceps tenodesis may be considered to restore upper limb strength.
: Biceps tenotomy involves simply cutting the long head of biceps tendon from its origin, allowing it to fall towards the elbow and relieving the source of pain. It produces the 'Popeye' deformity in approximately 40% of patients. Biceps tenodesis involves detaching and reattaching the tendon to the upper humerus, preserving its length and the normal contour of the arm. Tenodesis is generally preferred in younger or more active patients, while tenotomy suits older or less demanding patients.
: Yes, with appropriate modification. Heavy overhead lifting, pull-up movements and exercises involving strong elbow bending under load should be modified or avoided initially. Ms Razo will advise on which activities to continue, modify and avoid at each stage of rehabilitation.

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