The biceps is a great muscle with some intricacies that has provided decades of confusion for orthopedic surgeons. We finally think we have figured it out, but then again that’s what they said about VHS videotapes.
First the anatomy of the biceps muscle. It is made up of two tendons that attach to the scapula in two different places. The short head of the biceps starts at the part of the scapula called the coracoid. This is a pressure point and is right in front of the shoulder more towards the chest. It is bony and easily felt on thin arms. The long head of the biceps gets it name because it has to travel farther to get down the arm. Its tendon is felt right in front of the ball of the humerus. It travels in a little groove that is covered by a ligament and then travels underneath the pectoralis major tendon as it heads to the elbow and attaches to the radius of the forearm.
Now here’s where it gets fun. Roll up your sleeve and keep your elbow flexed at 90 degrees like it is resting on a chair. Point your thumb up in the air and check out your biceps. Now rotate your forearm so you are looking at your palm. What happened to your biceps? It contracted because that is called supination and the biceps is the strongest supinator in the body. So it not only flexes your elbow as it does when we do strict pull ups, but also supinates. This is important because if it tears it gives weakness with supination activities like using a screwdriver or opening a door.
The long head of the biceps is usually the culprit for pain in the shoulder. It can be irritated in its tunnel or in the shoulder itself with a tendonitis which is inflammation of the tendon. It can be seen as a red infiltration into the tendon.
Mild injuries can also result in microscopic tearing of individual tendon fibers. As the severity of an injury increases, larger tears can occur to the point where the tendon is partially torn or even completely ruptured. If a rupture occurs, the long head will usually fall distally toward the elbow causing what is called a Popeye deformity.
When these are reattached, it is called a biceps tenodesis where the long head is secured into the humerus to maintain its length, improve strength and avoid cramping of the biceps.
Age, inactivity, or over-activity can weaken a tendon which may lead to injury due to the decreased ability to endure repetitive motions and sudden loads. The important part of this is that pain usually precedes anything bad and is our body’s warning signal to us encouraging us to back off or else. Some individuals develop bone spurs at the acromion which can lead to wear and tear of their tendons. This is called Impingement Syndrome (topic to be discussed later). The biceps tendon can also be injured at its attachment site on top of the glenoid. This usually involves an avulsion, where the tendon is pulled off the bone and rendered unstable. This is called a SLAP tear or Superior Labrum Anterior Posterior tear. Stay tuned to learn about SLAP tears and how we can try to avoid them as a CrossFit community.
I can say that I have had patients that have returned after tenodesis but certainly check with your surgeon about this.
I hurt my left shoulder doing a squat clean. Caught the bar well below the rack in front of the shoulder. Felt a strong pull on my left. I started feeling instability and a little pain (2/10) during WODs since then. Took PT for 6 weeks. But I still had achy pain. It’s 4 months since the injury. Took an MRI and was diagnosed with Type 1 SLAP tear. Surgeon said its a very minor one and I could avoid surgery as its not my dominant arm. He recommended more PT, and doing workouts without too much overhead stuff. I am 33 and been doing crossfit for an year. Can type 1 tears be managed through a lot of PT and strengthening? I would rather have a surgery asap if this is going to bother me for years to come. Thanks.
Type 1 tears if they are small can be managed with strengthening, but every shoulder is different. You won’t lose much by trying PT first
I am 54 years old and about a year into crossfit. I have grown to love the sport and am looking forward to turning 55 and moving into the next masters division in next years open. Now the bad news, I ruptured the proximal biceps tendon in my left arm. I saw an orthopedist and his recommendation was to not have it surgically repaired. He informed me I would only lose about 10% of strength if I could live with the change in appearance. But this doctor is not a crossfitter, so I am reluctant to take this advice with the fear of not being able to perform close to my current level. Wondering what your thoughts are on the matter Dr. Sean
The teaching in the past has been to let it ride and not worry about it, but I have seen cosmetic deformity, cramping and weakness associated with that treatment plan.
Sometimes you can get swelling in the biceps muscle after vigorous exercise, usually not from just stretching. One thing to do is make sure the MRI was of the area involved. A shoulder MRI may not get all the way down the arm. The next doctor seems reasonable to see if the first one cannot find any issue.
Six weeks ago I noticed my right bicep swollen andv hardened after some stretching exercise and subsequently I could not straighten my arm I was getting kind of stabbing pain sporadically.I visited the orthopedic physician couple of times and he has not been able to understand the real reason of the swollen bicep despite having CT scan, Xray and MRI of shoulder. Since the basic issue still remains, he suggested I should visit a orthopedic oncology physician who shou determine if it is a tumor or something there of.. Does it sound normal ?
It is not a tendon tearing issue , he confirmed.
Any direction is appreciated,
Could be an achilles tendonitis, go to my site http://www.orthopedicsne.com and check out PT protocols for this if not better, you should be seen.
HiI had compartment syrdnome in my calves. About 5 years ago I had a full fasciotomy in both legs.I also have also always had short archilles, and hamstrings, and as such, have always had to do alot of stretching (for little gain).I have always been very involved in sport, however, following my fasciotomy I lost a lot of top end speed, and lacked spring, as such, my days of elite sport were over at 24.I am now trying to get into some long distance running, and am running a half marathon in 3 months.However, every time I run I get severe, and deep pain in my mid archilles after 10-15 min.I would appreciate any advice as to how I can manage the problem. I don’t mind some pain, but not agony.
321GOMD – Awesome stuff, very informative.
So, a few weeks ago, I developed some pain in my right aclhiles tendon, which I attributed to a new brand of shoe with a tight heel cup. I stopped using that shoe, and also took a break from my steep hill repeats and my calf raise exercises (which I usually do twice a week). I also iced after workouts, and used a heating pad at other times. I did not cut back my mileage or insert heel lifts.Over the past 10 days, the pain has disappeared completely when running, though I can still get some pain if I squeeze the tendon hard with my fingers (right at base of heel). However, I’ve noted a crackling sound when I engage the tendon, though (generally, by pushing my toes hard against something).Am I safe to assume that this is just part of the healing process, and that I can keep on running as long as there’s no pain? Should I start back with my calf raise exercises, or wait until the crackling is gone as well?Background I’m a consistently high mileage runner (about 75-80 mpw). I have very stretched aclhiles tendons, due to a life of horseback riding, and I do stretch my calf muscles appropriately. I do not take pain-killers of any type, because I prefer to use pain as a warning sign of injury ]
I don’t like the fact that you have tenderness and crackling still. I think you should be evaluated. Sean