A shoulder that catches and hurts

You lift a pot of water with your palm turned upward and feel a sharp twinge at the front of the shoulder where the biceps begins. You unscrew a jar and the pain returns at exactly the same spot.

Instability and degeneration of the long head of the biceps tendon (LHBT)

Sometimes you feel something snap in the shoulder when you rotate your arm. This is not a ‘biceps strain after the gym.’ It is instability or degenerative change of the tendon of the long head of the biceps, abbreviated LHBT.

What is actually happening?

The LHBT tendon begins deep in the shoulder joint and exits through a narrow groove between two projections of the humerus. A band of tissue holds it in this groove. When that band weakens, the LHBT starts popping out of the groove with every rotation of the arm. The tendon itself, used for years with every elbow bend, gradually wears and loses elasticity, whether or not it remains in the groove.

Instability is often the result of injury and may be accompanied by other damage. Degenerative changes develop over years, especially with overhead arm work in sports, climbing, or lifting.

How can you recognize it?

  • pain at the front of the shoulder exactly where the biceps begins when you press it with a finger,
  • snapping or cracking in the shoulder with movement and rotation,
  • pain radiating down the arm to the elbow when carrying something with the palm turned upward,
  • you avoid pull-ups or carrying heavier objects.

Why you should not wait

An unstable tendon rubs against the edge of the groove each time it snaps, which can cause recurrent inflammation, pain, and microtrauma and eventually lead to rupture. Degeneratively altered fibers are weaker and tear more easily, even with an ordinary sudden tug.

The earlier we stabilize or relieve the tendon, the lower the chance of complete rupture, after which the muscle slides toward the elbow and forms a visible bulge.

How we help

We begin with a dynamic shoulder ultrasound, which shows whether the long-head biceps tendon shifts in its groove, is thickened or frayed, and whether the problem also involves the rotator cuff tendons.

For milder changes, we begin with rehabilitation to strengthen the muscles stabilizing the shoulder and relieve the painful tendon. Injections may be considered as support during rehabilitation.

When this is not enough, we operate arthroscopically through several incisions a few millimeters in size, using a camera that displays the enlarged inside of the shoulder on a monitor. Depending on the tendon’s condition, we either cut it where it no longer serves its purpose, or cut it and reattach it lower down on the humerus with an anchor. The choice depends on the patient’s age and activity level.

There is one goal: a shoulder in which the biceps stops snapping and hurting.

Book a consultation

If you recognize these symptoms, do not wait until the tendon tears completely. Make an appointment for a consultation. We will assess what is happening to your biceps and tell you whether rehabilitation is enough or a procedure is needed.