Proximal Biceps Tendon Tear

Hi everyone,

According to an MRI I tore my proximal biceps tendon. I saw one Doctor and he said they don’t do surgery on that type of injury. I’m scheduled to see a 2nd Doctor at a better surgery center on Tuesday. I wanted to find out if anyone else had any experience with this? My MRI results are listed below. Thanks for any help and guidance that you may offer.

Report

EXAM: MRI-LEFT SHOULDER NON CONTRAST

HISTORY: M79.622 Left arm pain M25.612 Left shoulder stiffness
M25.512 Left shoulder pain
Findings

TECHNIQUE: Axial, coronal, and sagittal images of the left shoulder were
obtained on a 1.56 Tesla magnet.

COMPARISON: None.

FINDINGS:

BONE MARROW: No fracture or avascular necrosis.

acromioclavicular joint: There are mild acromioclavicular joint degenerative
changes. .

BURSITIS: None.

Rotator cuff tendons:

Diffuse thickening and edema of the supraspinatus and infraspinatus tendons
without tear.

There is a low-grade partial-thickness intrasubstance tear of the superior
fibers subscapularis tendon at the footprint on the background of tendinosis.

Biceps: The biceps tendon is torn from the anchor with retraction to below the
transverse ligament.

GLENOHUMERAL JOINT: There is bony proliferation of the posterior bony glenoid.
No high-grade cartilage loss.
Glenohumeral joint effusion is present.

labral ligamentous complex: Diffuse intrasubstance signal within the superior,
anterosuperior and anterior labrum. Diffuse intrasubstance signal and truncation
of the anteroinferior labrum and inferior intrasubstance labral.

Rotator interval: Exuberant edema in the rotator interval with fatty effacement.

coracoacromial and coracoclavicular ligaments: Intact.

MUSCLES: Normal signal characteristics and bulk without edema or atrophy.

Quadrilateral space: Normal without masses.

IMPRESSION:

Findings are present which can be seen in adhesive capsulitis.

Supraspinatus and infraspinatus tendinosis without tear.

Low-grade partial-thickness intrasubstance tear of the superior fibers
subscapularis tendon at the footprint on the background of tendinosis.

The biceps tendon is torn from the anchor with retraction to below the
transverse ligament.

Glenohumeral joint effusion.

Superior, anterosuperior to anterior to inferior labral tear.

ICD 10 -

1 Like

@FredMertz,

Been there done that! I dislocated my Left Shoulder 4 years ago and several months later watched my biceps tendon slide below my transverse ligament. It was fascinating. It only took several months, but the arm had a fantastic range of motion and little degradation of strength.

As a rehab-oriented clinician, I have walked this road with many patients. Typically surgeons don’t like to cut on this one as there are good conservative care outcomes. However, if they opt to “surge” on this, they will likely only do a re-attachment back to the head of the humorous as it causes more damage than benefit to reattach to the glenoid where it tore from.

In either case, the best advice you can do for yourself is to get more mobility in the thoracic spine, pelvis, and hips. Then work to get excellent scapular control and ensure your sternoclavicular joint is aligned well.

Lastly, I have seen remarkable things done with this kind of injury with PRP and “Stem Cell” therapies. Dr. Centeno has fellows all over the world. It’s worth a call to them since you have an MRI. Click for the link.

Good luck . - Doc

1 Like

Thank you for the info.

I see another doctor on Tuesday at a major sports and orthopedic Hospital.

The MRI report says:

“The biceps tendon is torn from the anchor with retraction to below the transverse ligament.”

I assume it will continue to retract.

If I don’t have this operated on it seems I’ll be functioning with only one bicep muscle. Plus, it’ll look freakish if/when it retracts entirely. So far there is no visible change.

1 Like

The bicep is a two headed muscle, hence the name bicep. So I wouldn’t say you’ll be functioning with just one bicep muscle. A human can manage fine with just the short head attached. There will be some strength loss at first but with training/rehab, most of the time you’ll be back to at least 90% of previous strength level pretty quickly (few months?) as the short hade takes over. Although most likely you will have “Popeye” type of bicep cosmetically if you choose the conservative treatment. I’ve seen lots of guys manage heavy lifting just fine with torn bicep long head.

The operation is pretty simple, done in full anesthezia or in a plexus block while awake and can be done in a few ways. It basically means just attaching the torn tendon to humerus like Dr GH described earlier. Reattachment to the original insertion is problematic and can cause more problems (shoulder pain etc.). You can of course break the newly made attachment again sooner or later, especially with heavy lifting and you may not have the chance of re-re insertion then. The older you get, there’s more risk of re-rupturing the tendon as most likely it’s been degenerated in the first place as it broke.

I don’t see what a PRP injection could do in this. The risks are minimal but so are the proven benefits unless you feel more confident with rehab with it etc.

Most of the time older dudes (40+`?) happily choose conservative treatment and most of the time younger dudes (at least below 30) are operated. The treatment is case dependent.

Hope this helps.