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Sports Injuries to the Shoulder and Elbow pp 281–292Cite as

Biceps Instability: With Versus Without Rotator Cuff Lesions

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Abstract

A thorough history and physical examination should be performed to obtain all necessary information and access for symptoms of biceps instability. Diagnostic injection of 1 % lidocaine in the glenohumeral can be helpful to reduce/eliminate pain from possible biceps pathology, especially in a patient with no pain or weakness with rotator cuff strength testing.

MR arthrogram is our preferred study of choice to assess the rotator interval and biceps pulley. Complete diagnostic arthroscopy with adequate visualization of the anterior and posterior biceps pulley along with the upper fibers of the subscapularis is critical. This includes dynamic range of motion of the arm (i.e., internal and external rotation) to assess for any subtle signs of biceps subluxation. Evaluation of the posterior biceps pulley with the arm in internal rotation is essential to assess for posterolateral biceps instability, especially in cases where the anterior footprint of the supraspinatus is torn.

The specific technique of operative treatment of biceps instability and any associated rotator cuff pathology should be left to the discretion of the treating surgeon. No specific method of biceps tenodesis or rotator cuff repair has proven to be superior.

Postoperative rehabilitation should be tailored to the specific procedure performed and technique utilized. In general, patients who undergo an isolated biceps tenodesis can progress quicker than those who undergo a concomitant rotator cuff repair.

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Authors and Affiliations

  1. The Shoulder Center at Baylor University Medical Center, 3900 Junius Street, Suite 740, Dallas, TX, 75246, USA

    Brody A. Flanagin MD, Kelly Fitzpatrick DO, Gi-Hyuk Moon MD & Sumant G. Krishnan MD

  2. Shoulder Service, Miulli Hospital, Acquaviva delle fonti-Ba, Italy

    Raffaele Garofalo MD

Authors
  1. Brody A. Flanagin MD
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  2. Kelly Fitzpatrick DO
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  3. Raffaele Garofalo MD
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  4. Gi-Hyuk Moon MD
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  5. Sumant G. Krishnan MD
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Corresponding author

Correspondence to Sumant G. Krishnan MD .

Editor information

Editors and Affiliations

  1. NEON Orthopaedic Clinic, Global Center for Shoulder, Elbow & Sports, Seoul, Korea, Republic of (South Korea)

    Jin-Young PARK

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© 2015 Springer-Verlag Berlin Heidelberg

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Flanagin, B.A., Fitzpatrick, K., Garofalo, R., Moon, GH., Krishnan, S.G. (2015). Biceps Instability: With Versus Without Rotator Cuff Lesions. In: PARK, JY. (eds) Sports Injuries to the Shoulder and Elbow. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-41795-5_24

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  • DOI: https://doi.org/10.1007/978-3-642-41795-5_24

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-41794-8

  • Online ISBN: 978-3-642-41795-5

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