Bicep tendonitis is a very common form of shoulder pain often experienced by people who perform excessive and repetitive overhead movements. This condition develops over time with pain felt in the front area of the shoulder.
It is found in individuals aged between 18 to 35 who are involved in sports, swimming, martial arts, or gymnastics. 95% of people experiencing biceps tendinitis are likely to suffer from rotator cuff tear or tear in the superior labrum anterior to posterior (SLAP) region too.
What is Biceps Tendonitis?
Biceps tendinitis is a condition in which inflammation occurs in the tendon causing pain. The biceps tendon constitutes of the long head and the short head. The long head of the biceps faces the most damage. In the early stages of tendinitis, the tendon becomes red and swollen and as the tendinitis develops, the tendon covering thickens and grows larger. In the late stage, the colour of the tendon darkens due to inflammation. The damage to the tendon results in tear and then may lead to deformity of the arm.
Biceps tendinitis can occur in the shoulder or elbow but it is highly unlikely for it to occur in both places at the same time. Although it can occur at the same time as rotator cuff tendonitis.
What causes Biceps Tendinitis?
There are many causes leading to biceps tendonitis:
- Activities involving repetitive use of the overhead movement of the arms
- Sudden injury or abrupt motion of the arm
- Weakness in the rotator cuff
- Hypermobility of the shoulder joint
- Tightness in the shoulder joint and muscles
- Degeneration of the tendons and muscles
- Weakness in the tendons due to aging
- Poor body posture and control of movements
- An abrupt increase in the exercise routine
Symptoms of Biceps tendinitis
The most recognizable symptom is sudden and severe pain in the upper part of the arm or elbow, depending on where the tendon is injured. Other symptoms also include:
- Sharp pain and tenderness in the front part of the shoulder or elbow
- A bruise may appear on the upper arm or elbow
- Weakness in the shoulder or elbow
- Trouble in performing a range of motions including rotating the palm down to palm-up position
- Pain that may spread to the neck or down the arm
- A change in the shape of the bicep in the upper arm
- Difficulty in performing daily activities that require a wide ROM
- Pain that may aggravate when resting at night
These symptoms vary from patient to patient and can be relieved using treatments.
Diagnosis for Biceps tendonitis
The doctor will review the patient’s medical history and will ask to describe the shoulder condition. The doctor will then perform a physical examination of the shoulder and the elbow to assess strength, range of motion, flexibility, and sensation. The doctor will also check areas near the shoulder to understand which area causes consistent pain for a clear diagnosis.
X-ray or MRIs are advised if the doctor finds the condition to be serious. MRIs and ultrasounds help in showing the soft tissues of the biceps tendons in great detail.
Treatment for Biceps Tendinitis
Biceps tendinitis is usually treated with simple traditional methods which include
- Rest is of utmost importance and the first step towards recovery. Activities that cause pain should be avoided
- Cold packs or ice also help in reducing the tenderness and lessen the pain
- Anti-inflammatory medicines and steroid injections are very effective and help in relieving pain and reduce swelling
- Physical therapy is always recommended as it helps in restoring the shoulder to its full functionality and also strengthens it
If the condition does not improve with nonsurgical treatment, the doctor may offer surgical options which have a high success rate.
Surgical treatments include:
- Biceps Tenodesis: the damaged part of the biceps is removed and the remaining section of the tendon is then reattached to the upper arm. The surgeon may choose to perform this procedure arthroscopically or through an open incision.
- Tenotomy: In severe cases, if the long head is damaged beyond repair the surgeon may simply elect to remove the tendon from its attachment. This surgery may lead to a Popeye bulge in the arm.
Surgery should only be considered if conservative methods fail or if there is severe damage to the bicep’s tendon.
How can Biceps Tendonitis be prevented?
General suggestions that can be followed to minimize the likelihood of biceps tendinitis are:
- Repetitive activities that require overhead motions should be avoided as it causes shoulder pain.
- The shoulder, neck, and back are at risk when the body has poor posture. Over a period of time, this leads to problems. A good body posture should be maintained to avoid discomfort.
- Lifting or carrying of heavy objects should be avoided and even if carried, the objects should be carried with both hands so that it doesn’t put abrupt pressure on one arm leading to tears.
- Strengthening exercises of the rotator cuff should be performed regularly as it restores movement in the shoulder and also provides flexibility.