Recently, I have received several inquiries, and encountered patients in the clinic, who had undergone “biceps tendon adjustment” procedures in the shoulder area at other facilities, performed by physiotherapists or chiropractors. These procedures are destined to fail due to simple anatomical facts.
The biceps brachii is a muscle on the front of the upper arm, with three tendons attaching it to the bones, transmitting force to facilitate movement. Two of these tendons are near the shoulder joint, one of which enters the joint itself. This tendon is often targeted in therapeutic procedures. Positioned at the front of the shoulder, it mainly lies within a groove on the humerus bone, and in its upper third, it enters the joint, crosses over the front of the humeral head, and attaches to the upper part of the socket. This tendon serves multiple roles: it partially stabilizes the shoulder joint at rest, contributes to dynamic stability during various movements, and assists in raising the arm away from the body.
Isolated injuries and inflammation of this tendon are rare. They are generally consequences of other shoulder kinematics disorders or damage to surrounding structures within or around the joint. Even a healthy tendon can be tender to the touch, with patients often pointing to the front of the shoulder as the painful area in numerous pathological processes. This fact, along with intraoperative findings where the tendon appears pathologically altered and inflamed as part of complex injuries or damage, and common ultrasound findings that show fluid accumulation or changes in shape or structure around the tendon, has led some clinicians to believe that shoulder pain may be caused by this tendon’s condition.
The scientific literature on the role of the long head of the biceps tendon in shoulder pain is ambivalent, and it can be interpreted according to one’s bias. If you want it to be the main cause, you can find evidence for that, and vice versa. Our extensive experience in treating shoulder dysfunction suggests that it is rarely the sole cause of symptoms, often being part of a complex set of processes leading to pain and limited mobility.
There is a simple part to this story, however. It’s this: the biceps tendon is either stable within its groove or it is dislocated/subluxated. There are two causes of dislocation: one is a very shallow groove, which is a genetic variation in the shape of the humerus and typically does not cause issues on its own. The other, far more common cause, is damage or rupture of connective structures that stabilize the tendon within its groove. Regardless of the cause of dislocation, it is NOT POSSIBLE to reposition the tendon back into its groove. Even if it were possible, it would dislocate again with the next shoulder movement. Therefore, all efforts, procedures, and “manipulative adjustments” to reposition or adjust the tendon in its groove are futile at best and harmful at worst. Some of these procedures can be aggressive and exacerbate an already painful shoulder.
The simple truth is that not every tenderness in the biceps tendon indicates dislocation or inflammation. A thorough examination of the shoulder complex by an experienced orthopedist and/or physiotherapist is necessary to determine the true causes of shoulder pain and dysfunction, which should then be treated accordingly. In such treatment, manual therapy plays a significant role and is a powerful tool in skilled and experienced hands. Manipulation of the biceps tendon does not fall within this category.
