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Diagnosis and Treatment of Biceps-Labrum Complex Injuries

Man throwing football

Dr. Stephen O’Brien, Orthopedic Surgeon, describes the biceps-labrum complex, an area where the biceps muscle of the arm connects to the shoulder. This region is a common source of injury for many athletes.

What is the biceps muscle? The biceps muscle of the arm is connected to the shoulder by two tendons- soft tissues that connect muscles to other muscles. These two tendons are called the long head of the biceps tendon and the short head of the biceps tendon. The long head of the biceps tendon connects to the shoulder’s labrum, which acts like a bumper guard or cushion around the rim of the shoulder’s socket.

What is the injury? Athletes are often told that they have a tear in their labrum, which causes them pain. However, this is not always the real cause of their pain. Some people even have one or multiple surgeries to repair a labrum tear, but still have no pain relief. Many times, the real problem is that the long head of the biceps tendon is pulled inside of the shoulder joint- not a labrum tear causing pain. Doctors often say that the tendon is pulled or sequestered in the shoulder’s joint, like a prisoner in a jail cell.

Biceps Injuries in Athletes:Injury to the biceps-labrum happens mostly in athletes who play sports involving overhead motions, such as baseball and football throwers, tennis players, swimmers, surfers, windmill softball pitchers and volleyball players. About 18 percent of all people are naturally more susceptible to the long head of the biceps tendon being sequestered. It’s important to ask your orthopedic physician to test for both injuries to the shoulder’s labrum and to the biceps tendons to determine the real source of pain.

Treatment:To treat this injury, take a break from the sport or activity. A cortisone shot may also help with inflammation in the area. However, surgery may be necessary. A procedure disconnecting the long head of the biceps tendon, and then reconnecting it to an area outside of the shoulder may cure the injury and prevent the tendon from being pulled back inside the shoulder joint. In most cases, pain is relieved without hindering any physical ability or athletic performance.

Dr. Stephen J. O’Brien is an Attending Orthopedic Surgeon at Hospital for Special Surgery, specializing in orthopedic surgery and sports medicine. Dr. O’Brien has also been actively involved in research throughout his career. He has authored 20 book chapters and 85 peer-reviewed or review articles. Currently, his research interests have focused on an algorithm he developed for the diagnosis and treatment of biceps-labral disorders.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.