Thoughts from the journey… Excerpts from a day in the life of Sherry McLaughlin


Biceps Tendon Irritation – A Wrong Move


I was blog surfing today and saw a link to an interesting article that came out two days ago:

Evidently, there is a bit of controversy regarding whether or not the biceps tendon is an important part of the throwing shoulder. One thing most can agree on is that chronic biceps tendonitis is often the cause of persistent anterior shoulder pain after a SLAP lesion repair.

Superior Labrum Anterior Posterior (SLAP) is a tear in the labrum, common in overhead athletes. As a student of biomechanics, my first question is, "What position of the humeral head would predispose one to a SLAP lesion?" And then, "What does the biceps tendon have to do with that?"

It is this author's experience that persistent biceps tendon pain occurs when the biceps tendon is placed in a long/weak position. Here are the options:
1. Elevated scapula (due to upper trapezius trigger point or elevated pelvis) - Sagittal Plane
2. Adducted scapula (uncommon) - Frontal Plane
3. Upwardly rotated scapula (due to upper trapezius or infraspinatus trigger points) - Transverse Plane

#1, 3 are the most common scapular positional faults that create overload to the biceps long head tendon. This is clinically confirmed by performing manual muscle test of the biceps pre- and post-treatment of the above trigger points.

In short, correct scapular position and the biceps irritation goes away. Interestingly enough, the elevated, upwardly rotated and protracted scapula is also a culprit in rotator cuff tendonitis and tears. And the position of the scapula is often a result of dysfunction somewhere else in the biomechanical chain.

It isn't surprising then that SLAP lesions, rotator cuff tendonitis and persistent biceps tendon pain are commonly associated. According the to article, if you just move the bicep tendon and affix it to the humerus, then you remove the offending tendon and the pain goes away. One study even sites that there was no change in performance. (Maybe it's because these guys actually are throwing from the hip).

I suspect we will find out the ramifications of moving or removing body parts that are part of our intricate design. Kind of like rebuilding an engine only to have a box of leftover parts. It might seem like everything works, but it always makes me a little bit nervous.

For those of you non-professional athletes out there suffering from chronic anterior shoulder pain, here is great news! There is a fix! And it doesn't include a knife or moving body parts around. I assure you these shoulders weren't injured because the bicep was in the wrong place. Moving it, at best, avoids the problem. It doesn't fix it.

For the clinicians out there, remember, the biceps tendon wasn't designed to work in a long/weak position. Fix it's starting length (i.e. fix scapular position) and restore normal functional rotational movement patterns (that means check the thoracic spine, the hip and the subtalar joint).

To quote Dr. James Andrews: The rotator cuff "is still the granddad of the problems" in pitchers' shoulders, but surgeons aren't satisfied with the success rate on SLAP repairs. We're all trying to figure it out — how to fix the damn thing.

My advice, put your ears to the shoulder and take your eyes and look elsewhere. There are real world solutions to this problem. It's our job to exercise those solutions and let the consumers at large know about their options. I promise you, when you solve one of these for yourself, you won't ever forget it--and neither will your patient.