FAQS on Biceps Tendonitis
Biceps tendonitis is the biggest threat to the career of baseball pitchers. Common to impact people aged between 18 and 35 and engaged in martial arts, gymnastics, contact sports, throwing activities, and swimming, the problem may be due to an independent inflammatory injury or rotator cuff disorders. It may become acute in older people with degeneration of muscle tendons.
What is biceps tendonitis?
Tendonitis refers to inflammation or irritation of tendon, the band of fibrous connective tissue attaching muscles with bones. Biceps tendonitis occurs when the foremost tendon responsible for “connecting the top head of the biceps muscle to the shoulder” is inflamed. In the medical annals, it is also called as “the inflammation of the long head of the biceps tendon” following inflammatory impact on that particular tendon.
Bicep tendonitis is one of the four types of injuries that affect the performance of bicep tendons. The other three are bicep tendon tear, impingement syndrome, and bicep tendon dislocations.
How does biceps tendonitis occur?
Bicep muscles responsible for providing flexibility to the elbow and the upper arm has two types of proximal tendons, which are located near the upper arm. The long head tendon connects with the shoulder socket and the short head tendon connects with the shoulder blade. The former is made to blend with the rim of cartilage around the shoulder socket to allow smooth yet controlled sliding of the humeral head while the latter provide mobility to the shoulder blade.
The long head tendon when gets inflamed and causes painful disorder that we call biceps tendinitis. Due to its very nature of structure and function, it is natural for the tendon to feel the pinch when tears appear in the rotator cuff or the labrum. Similarly, isolated injuries, nerve impingement, intra-articular disorders associated with wear and tear or instability may cause tendon inflammation or irritation leading to bicep tendonitis.
What are the symptoms of biceps tendonitis?
Biceps tendonitis symptoms include:
- Throbbing pain at front shoulder or elbow
- Aching pain in the top shoulder
- Pain radiates down the upper arm
- Aggravated pain with overhead or throwing activities
- Over-taxed and stiffened tendon
- Worsening pain with weight lifting
- Swelling and weakness in the bicep tendon
- Secondary consequence bicep tendon tear
- Tenderness affecting front shoulder
- Possible shoulder slipping or catching sensation
- Pain goes down with rest
- Red and swollen tendon that turns dark red with time
What causes biceps tendonitis?
- Stress or traumatic injury to bicep tendons
- Shoulder joint arthritis
- Labrum tears
- Damage to rotator cuff tendon
- Shoulder impingement
- Chronic shoulder instability
- Inflamed shoulder joint lining
- Overuse and degeneration causing tendon wear and tear
- Damage to collagen fibers
- Fall on the shoulder
- Transverse humeral ligament tears
- Shoulder dislocation
How is biceps tendonitis diagnosed?
As biceps tendonitis may occur isolated or secondary to various shoulder disorders, doctors make a detailed examination of symptoms. Symptoms were diagnosed through physical examination while patients are asked about their medical and occupational history to identify potential shoulder stress and injury.
Doctors may suggest a number of movements to check pain and weakness involving the biceps tendon. Special tests, including MRI and X-ray, are recommended to examine the possibility of rotator cuff tear, shoulder impingement, collagen damage, labrum tears, or shoulder instability.
Arthroscopy is also used to examine biceps tendons for tendonitis when there is the possibility of associated rotator cuff damage of joint injuries.
What are the treatment methods available for biceps tendonitis?
- Medication: Non-steroidal anti-inflammatory drugs are usually prescribed as the first line of treatment for biceps tendonitis. These drugs help alleviate pain by reducing inflammation at the initial stage.
- Pain management therapy: Rest, icing, physical therapy, controlled stretching and strengthening exercises are also suggested for the bicep tendon disorder. Rotator cuff strengthening helps as the tendons are more likely to be injured with rotator cuff damage.
- Surgical Intervention:
- Arthroscopy: Small incisions are made into the shoulder tendon and miniature repairs are done under imaging guidance.
- Repair surgery: The connection with the shoulder socket is repaired and strengthened to reduce stress on the biceps tendon.
- Biceps tenodesis: Surgical removal of the damaged section responsible for pain and rerouting or reattachment of the bicep tendons to the arm bone.
- Biceps tenotomy: Detaching the long head tendon when it is damaged beyond repair.
- Acromioplasty: Surgical removal of a tiny portion of the acromion front part to allow creation of enlarged space between the humeral head and it when the biceps tendonitis is traced to shoulder impingement.
- Non-Operative Pain Management Injections
- Anesthetic injections: Anesthetics, such as lidocaine, are injected into the inflamed area to reduce inflammation and pain. These medications keep the area numb and unproblematic for weeks.
- Corticosteroid injection: Steroids directly injected to ease inflammation, swelling, and pain in the inflamed area so that it does not hinder the functions of the tendons. This keeps the area free from inflammation for months at a time and possible for longer durations.
- Prolotherapy: Also known as regenerative injections, it involves injection of stem cells and platelet-rich plasma to the place of injury and inflammation. It relieves pain by setting apace the natural healing and regeneration of the damaged tendon part. These injections help reverse the effects of degenerative disorders and wear and tear.
Sethi N, Wright R, Yamaguchi K. Disorders of the long head of the biceps tendon. J Shoulder Elbow Surg. 1999;8(6):644–654.Distel, LM; Best, TM (June 2011). “Prolotherapy: a clinical review of its role in treating chronic musculoskeletal pain”. PM&R 3 (6 supplement 1): S78–S81.
Rabago, D; Best, TM; Zgierska, AE; Zelsig, E; Ryan, M; Crane, D (2009). “A systematic review of four injections therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood, and platelet-rich plasma”. British Journal of Sports Medicine 43 (7): 471–481
Ahrens PM, Boileau P. The long head of biceps and associated tendinopathy. J Bone Joint Surg Br. 2007;89(8):1001–1009.
Abrams JS. Special shoulder problems in the throwing athlete: pathology, diagnosis, and nonoperative management. Clin Sports Med. 1991;10(4):839–861.
Curtis AS, Snyder SJ. Evaluation and treatment of biceps tendon pathology. Orthop Clin North Am. 1993;24(1):33–43.
Zuckerman JD, Mirabello SC, Newman D, Gallagher M, Cuomo F. The painful shoulder: Part II. Intrinsic disorders and impingement syndrome. Am Fam Physician. 1991;43(2):497–512.
Speed CA. Fortnightly review: Corticosteroid injections in tendon lesions. BMJ. 2001;323(7309):382–386.
Larson HM, O’Connor FG, Nirschl RP. Shoulder pain: the role of diagnostic injections. Am Fam Physician. 1996;53(5):1637–1647.
Mariani EM, Cofield RH, Askew LJ, Li GP, Chao EY. Rupture of the tendon of the long head of the biceps brachii. Surgical versus nonsurgical treatment. Clin Orthop Relat Res. 1988;(228):233–239.