Sometimes the bicep tendon can come out of it's groove on the humerus.
Here's the skinny on shoulder anatomy and common issues.
The long head of the biceps originates from an area just above the glenoid fossa of the scapula.
The glenoid fossa is the part of the scapula that articulates with the head of the humerus (upper arm bone). There is a small bump of bone just above the glenoid fossa and this is where the long head of the biceps has its origin. Part of that biceps tendon also originates from the lip of the glenoid- a part called the glenoid labrum. The tendon then runs through the bicipital groove of the humerus. The tendon glides over the humeral head, stabilizing it in the glenoid fossa by preventing the humerus from riding up in the fossa when the arm is raised. The distal tendon insertion of the biceps tendon is on the radial tuberosity -the radius is one of the forearm bones- allows the biceps muscle to function mainly as an elbow flexor (bender)and forearm supinator (allows the forearm to rotate so that the palm faces up).
The long head of the biceps is at risk of injury and degenerative changes because of its mechanical function and nearness to the rotator cuff, bicipital groove, and acromion a bony projection at the top of the scapula). In fact, ruptures of the long head account for 96% of all biceps brachii injuries, while distal tendon and short head (the short head of the biceps also originates from the scapula but bypasses the bicipital groove. It also inserts distally at the radial tuberosity) ruptures account for 3% and 1%, respectively. The conditions that are most frequently associated with--and probably contribute to--ruptures of the long head of the biceps are rotator cuff pathology, spurs involving the bicipital groove, and shoulder instability.
When the long-head tendon ruptures, patients may feel a pop but do not always feel pain. They may report pain in the front of the shoulder that radiates to the biceps muscle belly or distal humerus. Repetitive overhead activities and lifting may make the pain worse, while rest usually brings relief. The pain may also be worse at night. Patients commonly have a history of injury to the shoulder or of chronic shoulder pain that got better after the rupture. When the patient's only symptom is a chronic ache in the front of the shoulder, it may be difficult to make a diagnosis.
Most patients present with unusual bulging of the biceps muscle on the affected extremity (“Popeye bicep”). The differences in the contours of the biceps can be observed clearly if the patient interlocks the fingers of both hands on top of the head and flexes the biceps.
Testing for biceps tendinitis is also important, since a positive finding may rule out a torn tendon. With the patient's arm at their side rotated slightly inward (internal rotation) and the elbow flexed to 90°, palpation of the biceps tendon may reveal tenderness in the bicipital groove, indicating probable biceps tendinitis.
Strength testing may reveal weakness which can be a sign of tendinitis or of tendon rupture. Biceps strength may be tested more specifically by having the patient bring the arm to the side, hold the elbow at 90° flexion with the forearm supinated (forearm turned so that the palm is facing up), and then flex the elbow against resistance.
Since biceps problems are often associated with impingement syndromes (rotator cuff pinched between the roof of the scapula and the head of the humerus), the assessment should include a complete exam of the patient's shoulder. Most patients who have a ruptured biceps tendon will have full range of motion in both shoulders and elbows.
Diagnosis can usually be made on the basis of the history and physical exam. X-rays of the shoulder can be helpful in the evaluation of biceps tendon ruptures thought to be associated with other shoulder pathology. Special views need to be taken.
MRI may be useful in assessing biceps tendon anatomy and associated rotator cuff and shoulder joint pathology. MRI should be considered in patients who have clinical evidence of an associated rotator cuff tear and in those who want to have their biceps surgically repaired.
Ruptures of the distal insertion of the biceps tendon, though less common than those of the long head, are associated with more long-term problems.
Treatment of a ruptured long head is usually conservative. The immediate goals of treatment are the maintenance of shoulder range of motion and the reduction of inflammation and pain with the use of anti inflammatory drugs, rest, and ice. After that, strengthening exercises for the shoulder and elbow flexors can be started. Any associated problems of the biceps or shoulder also need to be treated to speed the patient's return to activity.
Some physicians recommend operative treatment in younger patients who require supination strength (the ability to rotate the forearm so that the palm faces up) in activities such as carpentry or auto mechanics. Some athletes choose to have a ruptured long head surgically repaired in order to restore symmetry to the biceps muscle. The best surgical results are achieved when the repair is performed within 3 to 4 weeks of the injury. The procedure is called a tenodesis. This involves attaching the proximal tendon to the proximal humerus to restore a normal contour to the biceps belly and symmetry with the other biceps muscle.
Ruptures of the biceps tendon are most common in middle-aged patients, but this injury should also be considered in the young competitive or recreational athletes with shoulder complaints. A thorough evaluation should include common shoulder pathologies such as rotator cuff tendinitis. Conservative therapy usually allows patients to resume their activities without significant deficits.
Also the labrum could be an issue.
The Bankart lesion is a specific injury to a part of the shoulder joint called the labrum. The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus inherently unstable.
To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a labrum that forms a cup for the end of the arm bone (humerus) to move within. This cuff of cartilage makes the shoulder joint much more stable, yet allows for a very wide range of movements (in fact, the range of movements your shoulder can make far exceeds any other joint in the body).
When the labrum of the shoulder joint is torn, the stability of the shoulder joint is compromised.
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As the shoulder pops out of joint, it often tears the labrum, especially in younger patients. The tear is to part of the labrum called the inferior glenohumeral ligament.
What happens after sustaining a Bankart injury?
Typical symptoms of a Bankart lesion include a catching, aching, and susceptibility to dislocation; often patient will complain that they cannot "trust" their shoulder. Diagnosis can be difficult as these injuries do not always show up well on MRI scans. This is more of a clinical diagnosis with the definitive diagnosis of a Bankart lesion made at the time of surgery. Patients who sustain a Bankart injury are at much higher risk for dislocating their shoulder again. Treatment of a Bankart lesion often depends on whether or not a patient has recurrent episodes of shoulder instability.
What is the treatment for a Bankart lesion?
When there is suspicion for a Bankart lesion, attempts at physical therapy to strengthen the shoulder may help to reduce the risk of repeat dislocation. If strengthening does not help the problem, shoulder arthroscopy can be performed, and the injury can be definitively diagnosed and treated. A Bankart repair is surgery to repair the torn ligament back to the shoulder socket. The actual Bankart repair can either be performed through an arthroscope or through an incision over the front of the shoulder.
Whether or not a Bankart repair is done arthroscopically or through an incision (a so-called open Bankart repair) depends on several factors. An open Bankart repair is still widely considered the "best" repair. However, as arthroscopy continues to develop, an arthroscopic Bankart repair is becoming more widely accepted. You should discuss with your surgeon which procedure is best for your situation.
Either way get it checked out.
If you go to a Chiropractor, look for one who does extremeties, the CCEP or CCSP certifications is the top dog in this field.
I have mine, thanks to Dr. Kevin Hearon- The Master.
Surgery is a last resort, the body does heal itself, and cutting it up always adds more scar tissue.
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