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Rotator Cuff
& Biceps

Rotator Cuff & Biceps: Shoulder Pain Relief

The rotator cuff is comprised of four muscles with tendons that surround the ball and holds it in the shoulder socket. The primary function of these muscles and tendons is to hold the humeral ball in the shoulder socket and provide power to the shoulder.

A rotator cuff tear occurs when one of those tendons pulls off the bone itself. This can occur as a result of age, sporting activities, traumatic accidents, or just typical daily life activities.

Symptoms of a rotator cuff tear could include:

  • Pain deep in the shoulder and upper arm
  • Pain with shoulder activity
  • Inability to perform overhead activities because of weakness
  • Shoulder pain that radiates to the elbow and often disturbing sleep

Care for shoulder tears has advanced significantly over the last few decades. We now have a very effective spectrum of treatment options that give a high rate of clinical success.

Conservative Treatment Options

  • Physical therapy to strengthen the surrounding muscles
  • Home exercise therapies
  • Anti-inflammatory medications
  • Pain medications
  • Cortisone injections

These measures won’t fix the rotator cuff tendon tear but can improve pain and ability to perform everyday activities. One disadvantage of the conservative approach is that the rotator cuff tear can get larger over time, making the tear harder to repair and decreasing the likelihood of healing after repair.

Rotator Cuff Repair

Many patients with an extensive rotator cuff tear cannot lift their arm, even for activities of daily living, such as dressing, eating, and reaching a shelf. For these patients, we often recommend rotator cuff repair. This surgery repairs the rotator cuff by stitching the torn tendon back to the bone, through minimally invasive arthroscopic techniques.

Arthroscopic surgery, a technique that repairs your shoulder joint making only small incisions, is ideal for rotator cuff repairs because it’s minimally invasive, doesn’t disrupt any muscles, and generally leads to a faster recovery. Additionally, because arthroscopic incisions are small and irrigation fluid is utilized throughout the procedure, it has an extremely low infection rate.

Often a severe rotator cuff tear is accompanied by arthritis, or destruction of the cartilage, in the shoulder which can be difficult to repair.  This is a situation where reversed total shoulder replacement can help.

Long Head of Biceps

There are two “heads” of the biceps tendon that attach to the shoulder. The “long” head slides through a groove under the pectoralis major tendon. That groove continues between two tendons of the rotator cuff and attaches to the top of the shoulder socket via the labrum. The “short” head of the biceps attaches to the coracoid process of the shoulder blade (scapula). The long head of biceps is more relevant to shoulder issues, as it can be involved with labral tears and can tear itself. The long head of biceps is commonly released or repaired during a rotator cuff repair. We prefer to perform a repair in most cases, a procedure that is called a “tenodesis”.  

It’s interesting that the long head of the biceps can rupture and cause little symptoms, in fact on many occasion spontaneous “rupture” or release of the shoulder from the socket can result in improvement of a patient’s shoulder pain. Rarely the rupture results in symptoms of spasm and tightness. If these symptoms don’t improve with time the long head of biceps can be “retensioned”, pulled higher and reattached to the arm bone.

Most studies have shown that release of the long head of biceps results in little to no effect on total biceps or arm function, as the short head is the stronger of the two and can compensate well for its smaller counterpart. Nonetheless our approach during most surgical procedures on the shoulder is to “tenodesis” the long head of biceps by fixing it to the soft tissue and bone in its groove.