Rotator Cuff Tendonitis and A Shoulder Tendon Rupture

       

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Sometimes patients who have been suffering from long term shoulder pain will develop a sudden worsening of this long term pain and have to revisit the doctor. Oftentimes this visit will involve an MRI in order to discover the nature of this resurgent pain.

It is not uncommon when someone has had years of shoulder pain to find a rupture of their biceps tendon, as is often the case in scenarios like the one above. This causes great distress amongst patients and typically represents accumulation of years of inflammation in the rotator cuff area.

Anatomically speaking, the biceps tendon longhead of the biceps tendon inserts deeply into the shoulder joint and attaches fairly close to where the primary inflammation of rotator cuff tendonitis. Frequently, when the rotator cuff is inflamed, the patient will have a cycle of inflammation, pain, and there is some collateral damage unfortunately when the longhead of the biceps tendon is surrounded by this inflammation and swelling.

The surprising aspect of this tendon rupture is that it does not particularly impair the patient’s functionality of their arm. The superior aspect of the bicep where it attaches to the upper arm has actually two attaches. The longhead of the biceps tendon accounts for anchoring the smaller portion of the muscle. Additionally, when this part of the muscle has been exposed to so much inflammation, it will become weaker over time, but may not necessarily impair their shoulder's daily functionality.

In this case, the patient may have this loss of the tendon, but the other superior attachment of the biceps tendon will basically be able to give them adequate strength and function. So, if someone’s bicep tendon does rupture, it typically means they have a fairly severe rotator cuff problem. What it does not mean is that it is absolutely necessary that they get surgery. Sometimes patients shoulders' will get better with physical therapy, a comparatively easier solution. This is why all people should have a trial attempt at physical therapy even if they go to their doctor at their initial assessment with a ruptured biceps tendon. Certainly some of these people will end up with rotator cuff reconstruction, however, the patient should know that most of the time; the biceps tendon is not reattached because it frankly doesn’t need to be.

Michael Carroll, MD is a board certified family physician with a special interest in sports medicine. He is the founding partner of Creekside Clinic, LLC, a progressive primary care center in Traverse City, Michigan and a member of both the American College of Sports Medicine, and the American Academy of Family Physicians.

He also holds an interest in conditions that affect the shoulder joint, such as rotator cuff tendonitis. He is also the author of Shoulder Pain Talk, a blog dedicated to educating the thousands of Americans who face shoulder pain on a daily basis.