What is biceps tendon dislocation?

Biceps tendon dislocation is an injury caused by instability of the long head of the biceps tendon, which moves out of its groove.

This condition is often related to tears of the subscapularis and supraspinatus tendons, other rotator cuff injuries, and excessive strain from lifting very heavy objects.

The condition is often overlooked or misdiagnosed as the cause of shoulder pain, but its occurrence is not that rare.

When a biceps tendon is dislocated, it usually moves to a medial position. It doesn’t typically occur on its own; it’s often a consequence of a tear in the subscapularis tendon or a tear in the transverse ligament at its insertion point, which dislocates the biceps tendon and relocates it to the area where the subscapularis tendon is located.

If there are any fibrillar changes in the biceps tendon, it is an indication of a degenerative lesion, dislocation, or rupture, and is also a sign of other shoulder conditions, specifically involving the rotator cuff.

A biceps tendon dislocation usually causes sudden, sharp pain in the front of the shoulder, especially when performing overhead movements or when the arm is rotated.

The patient may also feel a snapping or displacement sensation within the shoulder, followed by muscle weakness, particularly when trying to flex the elbow or rotate the palm upwards (supine position).

Over time, the pain can become persistent and worsen with physical activity. Sometimes a visible deformity known as the “Popeye sign” can be seen, where the biceps muscle appears to have dropped down due to the tendon’s rupture or displacement.

Additionally, localized tenderness, swelling, and a reduced range of motion in the affected shoulder can be present.

Diagnosis begins with a detailed clinical evaluation and physical tests, including palpating the front of the shoulder and performing maneuvers that reproduce the pain. These include the Yergason’s test or the Speed’s test, both of which help detect the intensity or displacement of the biceps tendon. They also allow for an assessment of the affected arm’s range of motion and strength.

To confirm the diagnosis and rule out associated injuries such as rotator cuff tears or labral tears, imaging studies are used.

Dynamic ultrasound allows for the visualization of tendon displacement during movement, and an MRI provides a detailed image of the soft tissues and joint structures, which helps with a complete evaluation of the damage.

Treatment varies depending on the severity of the biceps tendon dislocation and the patient’s level of physical activity.

For mild cases or in older individuals with a low physical demand, the management is conservative and may include rest, ice application, anti-inflammatory medication, physical therapy, and progressive strengthening of both the arm and shoulder. The goal here is to control pain, reduce swelling, and restore functionality.

In young patients, athletes, or if there are associated injuries, surgical treatment is usually the preferred option. The choices include tenodesis, which is the fixation of the tendon to another part of the bone, or tenotomy, which is the release of the tendon.

Both procedures can be performed arthroscopically or through open surgery. A rehabilitation program will be required afterward to regain both strength and mobility in the shoulder.

At the Orthopedics and Traumatology Center of Centro Médico ABC, we can provide you with specialized care. Contact us!