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The long head of the biceps brachii tendon arises within the shoulder joint capsule and exits the joint deep to the supraspinatus and subscapularis rotator cuff tendons in the rotator interval. This means that the long head of the biceps tendon sits just deep to the rotator cuff tendon, and can also be injured along with the rotator cuff tear.
Pain from the biceps brachii tendon is rarely due to inflammation. In fact, there is no evidence that the root cause of biceps tendon pain is coming from acute inflammation of the tendon.
Histologic studies looking at the tendon architecture under a microscope showed no evidence of acute inflammation and tendon changes are consistent with the chronic degenerative process (Streit et al 2015).
The clinical presentation of the long-head biceps tendon and rotator cuff pathology is similar.
SLAP lesions involve a tear of the long head of the biceps tendon at its anchor within the shoulder joint and can also have overlapping symptoms.
Clinical exam findings can sometimes distinguish between these two tendinopathies, but often imaging with musculoskeletal ultrasound or MRI is needed to confirm the diagnosis. Differential injections with ultrasound guidance can also help confirm the location of the pain.
In orthopedics, these injuries are often managed conservatively with NSAIDs, activity modification, physical therapy, and cortisone injections.
Platelet-rich plasma (PRP) injections have been well-studied in the shoulder for the rotator cuff. One limitation to these studies is that in many cases the biceps brachii tendon was not treated with the rotator cuff. These lesions often co-occur and PRP has been shown to be helpful for proximal biceps tendinitis (Moon et al 2011).
Surgical options for proximal biceps tendons include biceps tenotomy vs. biceps tenodesis, both of which can be performed arthroscopically.
When lesions of the biceps brachii tendon are detected during an arthroscopic rotator cuff repair, the biceps tendon is often treated (Mardani-Kivi et al 2019). The orthopedic literature is starting to recognize the importance of addressing the biceps brachii lesions when they co-occur, although the surgical literature for the treatment of both of these tendons at the same time remains limited (Gartsman et al 1998; Streit et al 2015).