Biceps Tendonitis or Tendinitis- Causes and Treatment

Definition- Biceps Tendonitis

Biceps Tendonitis is caused by micro-tears in the tendon and it is called tendonitis (sometimes spelled “tendinitis”). Even though tendons are tough, if you overuse them they can become sore and painful. Tendonitis can occur because of repetitive motion. For instance, professional baseball players, swimmers, tennis players, and golfers are at risk for tendonitis in their shoulders, arms, and elbows. Tendonitis can also occur because of a sudden, serious load to the tendon.

Biceps anatomy

You can get biceps tendonitis in the shoulder or at the elbow. It is unusual to have tendonitis in both places at the same time. In the shoulder, biceps tendonitis can occur at the same time as rotator cuff tendonitis as it is part of the rotator cuff complex.

Biceps Tendonitis

History of Biceps Tendonitis

Leonardo da Vinci expressed the original idea of the biceps acting as a supinator in a series of annotated drawings made between 1505 and 1510; in which the principle of the biceps as a supinator, as well as its role as a flexor to the elbow,  were devised.

However, this function remained undiscovered by the medical community as da Vinci was not regarded as a teacher of anatomy, nor were his results publicly released. It was not until 1713 that this movement was re-discovered by William Cheselden and subsequently recorded for the medical community.

It was rewritten several times by different authors wishing to present information to different audiences. The most notable recent expansion upon Cheselden’s recordings was written by Guillaume Duchenne in 1867, in a journal named Physiology of Motion. To this day it remains one of the major references on supination action of the biceps brachii.

Biceps Tendonitis Epidemiology 

• The incidence of biceps tendon injury in sport and different occupations is unknown.
• Bicipital tendinopathy occurs in a variety of sports including weightlifting, tennis, wheelchair athletics (and general wheelchair use), cricket, baseball, kayaking and other sports where overhead activity is involved.
• Degenerative tendinosis and biceps tendon rupture are usually seen in older patients.
• Isolated tendinopathy often presents in young or middle-aged patients but the exact incidence is unknown.

Biceps Tendonitis risk factors

There are several factors which can predispose patients to develop biceps tendonitis. These need to be assessed and corrected with direction from a physiotherapist. Some of these factors include:

• Joint stiffness (particularly the elbow)
• Muscle tightness (particularly the biceps)
• Inappropriate or excessive training
• Inadequate warm-up
• Muscle weakness

Causes

• If the rotator cuff muscles do not have adequate strength, the humerus head migrates upward in the socket whenever you do any overhead lifting exercise.
• As in the bottom of a pull-up, it is possible to descend through a rep and have your upper arm travel over your head. The important idea is that if you have an unbalanced rotator cuff, you may have a problem once the arm travels past shoulder height.
• When this happens without sufficient strength, your humeral head will migrate too far upwards. This can cause the structures that sit just above the humeral head and just below the shoulder joint’s acromion or roof to pinch and impinge.
• The tendon of the biceps long head is jammed against the joint’s roof and is pinched. Repeating this process over and over (as with any series of sets and repetitions in exercises that place the arms overhead) will result in a possible breakdown and tendon fraying.
• Usually, the first stage of this is seen in an inflamed tendon of biceps that results in bicep tendonitis. The irony again is that the condition is probably not aggravated by traditional biceps curls.
• Indeed, by stimulating blood flow to the muscle, you can actually help the situation speed up healing by including curls instead of avoiding them when it hits. However, the amount of overhead pressing, bench pressing or even the position of your arms during squatting is what you would like to change.
• All of these exercises are much more likely to bother a bad shoulder once it is already inflamed or they are causing the pain in the first place. Make adaptations to your training to continue to work out without having to skip arm day altogether.

Symptoms of Biceps Tendonitis

The main symptoms of biceps tendonitis are a pain in front of the shoulder and tenderness to the touch. In addition:

• The pain generally gets worse when performing any overhead or lifting activities
• In some patients, the pain will radiate down the elbow or towards the neck
• An occasional “snapping” sound may also be heard when moving the shoulder, or a “catching” or “clicking” sensation may be felt
• As a result of pain and other symptoms, there may also be muscle weakness around the shoulder joint when reaching overhead or lifting/carrying objects

If the biceps has been torn, in addition to the above symptoms, patients may also experience:

• Sudden, sharp pain in the upper arm immediately after the injury
• You may also hear a “pop” or “snap”
• Some patients notice bruising from the middle of the upper arm down to the elbow

Biceps Tendonitis complications

Complications after biceps tenodesis are uncommon. Over a 3-year period, researchers studied 353 people who had gone through the procedure and found only 2 percent experienced complications.

Documented complications after biceps tenodesis include:

• Re-injury to the tendon or nearby bones
• Continuing pain
• Problem with attachment to the bone
• Nerve injury
• Change in the arm’s appearance

One of the complications can be a condition known as Popeye’s deformity, named after the muscled cartoon character.

If a tendon is injured, torn, or otherwise becomes unattached from the shoulder joint, it can bunch up. It can then create a bulge along the arm, which looks like one of Popeye’s muscles.

It is reported that 15 percent of individuals who undergo biceps tenodesis eventually need to have additional surgery.

Biceps Tendonitis diagnosis 

• Your doctor will first take a detailed medical history. You will need to answer questions about your shoulder, if you feel pain or weakness, and how this is affecting your regular activities. You’ll also be asked about past shoulder pain or injuries.
• The physical exam is often most helpful in diagnosing biceps tendonitis. Your doctor may position your arm to see which movements are painful or weak. Available arm motion is checked. And by feeling the biceps tendon, the doctor can tell if the tendon is tender.
• Special tests are done to see if nearby structures are causing problems, such as a tear in the labrum or in the transverse humeral ligament. The doctor checks the shoulder for impingement, instability, or rotator cuff problems.
• X-rays are generally not needed right away. They may be ordered if the shoulder hasn’t gotten better with treatment. An X-ray can show if there are bone spurs or calcium deposits near the tendon. X-rays can also show if there are other problems, such as a fracture. Plain X-rays do not show soft tissues like tendons and will not show biceps tendonitis.
• When the shoulder isn’t responding to treatment, magnetic resonance imaging (MRI) scan may also be ordered. An MRI is a special imaging test that uses magnetic waves to create pictures of the shoulder in slices. This test can tell if there are problems in the rotator cuff or labrum.
• Arthroscopy is an invasive way to evaluate shoulder pain that isn’t going away. It is not used to first evaluate biceps tendonitis. It may be used for ongoing shoulder problems that haven’t been found in an X-ray or MRI scan. The surgeon uses an arthroscope to see inside the joint. The arthroscope is a thin instrument that has a tiny camera on the end. It can show if there are problems with the rotator cuff, the labrum, or the portion of the biceps tendon that is inside the shoulder joint.

Treatment and medications for Biceps Tendonitis

Nonsurgical Treatment

Biceps tendinitis is typically first treated with simple methods.

Rest: The first step toward recovery is to avoid activities that cause pain.

Ice: Apply cold packs for 20 minutes at a time, several times a day, to keep swelling down. Do not apply ice directly to the skin.

Nonsteroidal anti-inflammatory medicines: Drugs like ibuprofen and naproxen reduce pain and swelling.

Steroid injections: Steroids such as cortisone are very effective anti-inflammatory medicines. Injecting steroids into the tendon can relieve pain. Your doctor will use these cautiously. In rare circumstances, steroid injections can further weaken the already injured tendon, causing it to tear.

Physical therapy: Specific stretching and strengthening exercises can help restore range of motion and strengthen your shoulder.

Surgical Treatment

• If your condition does not improve with nonsurgical treatment, your doctor may offer surgery. Surgery may also be an option if you have other shoulder problems.
• Surgery for biceps tendinitis is usually performed arthroscopically. This allows your doctor to assess the condition of the biceps tendon as well as other structures in the shoulder.
• During arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments.

Repair: Rarely, the biceps tendon can be repaired where it attaches to the shoulder socket (glenoid).

Biceps tenodesis: In some cases, the damaged section of the biceps is removed, and the remaining tendon is reattached to the upper arm bone (humerus). This procedure is called a biceps tenodesis. Removing the painful part of the biceps usually resolves symptoms and restores normal function.

Tenotomy: In severe cases, the long head of the biceps tendon may be so damaged that it is not possible to repair or tenodese it. Your surgeon may simply elect to release the damaged biceps tendon from its attachment. This is called a biceps tenotomy. This option is the least invasive but may result in a Popeye bulge in the arm.

Surgical complications: Overall, complication rates are low, and your surgeon can correct them without difficulty.

Infection, bleeding, stiffness, and other problems are possible complications. These are more likely to occur in open surgical procedures than in arthroscopic surgeries.

Rehabilitation: After surgery, your doctor will prescribe a rehabilitation plan based on the procedures performed. You may wear a sling for a few weeks to protect the tendon repair.

You should have immediate use of your hand for daily activities such as writing, using a computer, eating, or washing. Your doctor may restrict certain activities to allow the repaired tendon to heal. It is important to follow your doctor’s directions after surgery to avoid damage to your repaired biceps.

Your doctor will soon start you on therapeutic exercises. Flexibility exercises will improve range of motion in your shoulder. Exercises to strengthen your shoulder will gradually be added to your rehabilitation plan.

Prevention of Biceps Tendonitis

The best way to prevent biceps tendinitis is to:

• Warm up and stretch properly
• Use proper form and technique
• Take a break from your regular routine
• Use proper workplace supports, such as wrist guards for your mouse and keyboard, or ergonomic keyboards.