Colloquially referred to as biceps of the upper arm, these large muscles are well-known for being amongst the most impressive physical traits of the human body. The biceps brachii consists of two heads which protrude during muscle contraction and account for its unique shape. The long head of the biceps is described as the thin, long, and strong ‘‘cord-like’’ structure that intra-articularly attaches to the shoulder’s ‘‘cavity’’, known as the glenoid cavity.
In conjunction with the tendons that form the rotator cuff (the subscapularis, supraspinatus, infraspinatus and teres minor tendons), the long head of the biceps functions incessantly as it partakes in all shoulder movements. The long head’s anatomical position and its ‘‘connection’’ to the rotator cuff, and particularly the supraspinatus tendon which it passes through, provide explanation as to why long head biceps tendonitis is rarely an isolated case of shoulder injury. It is commonly accompanied by other shoulder conditions, such as shoulder impingement syndrome, extensive inflammation of the shoulder’s rotator cuff, arthritis or chronic shoulder instability.

Inflammation of the long head of the biceps tendon is mainly caused by tendon degeneration in the course of time. Furthermore, there is a higher risk of developing long head biceps tendonitis in cases where there is added strain to the shoulders as a result of repetitive overhead movements.
The long head of the biceps, regardless of the performed muscle activity and in all shoulder movements, slides into its ‘‘groove’’ (sheath). Primary symptoms of long head biceps tendonitis include tenderness to palpation over the tendon, pain during resisted elbow flexion, as well as pain during pronation (hand rotation where the palm is turned downwards).

Diagnosis for long head biceps tendonitis is based on the patient’s detailed medical history, which is obtained by the orthopedist, as well as physical examination of the patient’s affected shoulder in order to evaluate the shoulder’s range of motion, strength or apparent signs of shoulder instability. Specialized clinical tests are performed in order to assess the level of functionality of the injured biceps. X-rays, in spite the fact they only display bones, can reveal any additional joint problems, whereas MRI scans provide a highly detailed imaging of the biceps tendon.
For the majority of cases, and similarly to rotator cuff tendonitis, conventional treatment is recommended which includes rest, medication, shoulder suspension, application of ice, cortisone, and physiotherapy sessions in the post-acute stage of the condition. However, in cases of frequent relapses, unsuccessful conventional treatment, as well as concurrent shoulder injuries which affect the patient’s quality life, arthroscopic surgical treatment is recommended.
In cases of young patients with high functional demands, the selected treatment option involves fixation of the long head biceps tendon to the humerus bone with the use of suture ‘‘anchors’’ (biceps tenodesis). Alternatively, and mainly in cases of severe long head biceps tendonitis, arthroscopic tenotomy is performed in order to surgically release and remove the injured tendon.
Postoperatively, the patient can immediately start using the surgically repaired shoulder in daily basic activities. Muscle strengthening exercises are important for restoring shoulder mobility, whereas the restriction of physical activities following surgery is usually recommended to athletes.  

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