Courtesy of AAOS/OrthoInfo
Biceps Tendinitis
Long head of biceps tendinitis (or tendonitis) is inflammation or irritation of the upper biceps tendon. The biceps tendon is a strong, cord-like structure connecting the upper end of the biceps muscle to the bones in the shoulder. Pain in the front of the shoulder and weakness are common symptoms of biceps tendonitis. Rest and medication often helps relieve these symptoms. In some cases, surgery is necessary to treat this condition.
Biceps Tendinitis
Long head of biceps tendinitis (or tendonitis) is inflammation or irritation of the upper biceps tendon. The biceps tendon is a strong, cord-like structure connecting the upper end of the biceps muscle to the bones in the shoulder. Pain in the front of the shoulder and weakness are common symptoms of biceps tendonitis. Rest and medication often helps relieve these symptoms. In some cases, surgery is necessary to treat this condition.
Anatomy
Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).The ball or humeral head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps your arm centered in your shoulder socket. These tissues are called the rotator cuff. They cover the head of your upper arm bone and attach it to your shoulder blade.
The biceps muscle is in the front of your upper arm. It helps you bend your elbow and rotate your forearm. It also helps keep your shoulder stable.
The biceps muscle has two tendons that attach it to bones in the shoulder. The long head attaches to the top of the shoulder socket (glenoid). The glenoid is lined with soft cartilage called the labrum. This tissue helps the head of the upper arm fit into the shoulder socket. The short head of the biceps tendon attaches to a bump on the shoulder blade called the coracoid process.
Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).The ball or humeral head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps your arm centered in your shoulder socket. These tissues are called the rotator cuff. They cover the head of your upper arm bone and attach it to your shoulder blade.
The biceps muscle is in the front of your upper arm. It helps you bend your elbow and rotate your forearm. It also helps keep your shoulder stable.
The biceps muscle has two tendons that attach it to bones in the shoulder. The long head attaches to the top of the shoulder socket (glenoid). The glenoid is lined with soft cartilage called the labrum. This tissue helps the head of the upper arm fit into the shoulder socket. The short head of the biceps tendon attaches to a bump on the shoulder blade called the coracoid process.
Description
Biceps tendinitis is inflammation of the long head of the biceps tendon.
Biceps tendinitis frequently occurs along with other shoulder problems. In many cases, there is also damage to the rotator cuff tendon. Other problems that often accompany biceps tendonitis include:
In the early stages of biceps tendinitis, the tendon becomes red and swollen. As tendonitis develops, the tendon sheath (covering) can thicken. The tendon itself often thickens or grows larger.
The tendon in these late stages is often dark red in color due to the inflammation. Occasionally, the damage to the tendon can result in a tendon tear, and then deformity of the arm (a "Popeye" bulge in the upper arm).
The tendon may also become unstable and shift in and out of the groove in which it usually resides. This instability of the tendon itself can be very painful and cause a popping sensation in the front part of the shoulder.
Biceps tendinitis is inflammation of the long head of the biceps tendon.
Biceps tendinitis frequently occurs along with other shoulder problems. In many cases, there is also damage to the rotator cuff tendon. Other problems that often accompany biceps tendonitis include:
- Arthritis of the shoulder joint
- Tears in the glenoid labrum
- Chronic shoulder instability
- Shoulder impingement
- Other diseases that cause inflammation of the shoulder joint lining
In the early stages of biceps tendinitis, the tendon becomes red and swollen. As tendonitis develops, the tendon sheath (covering) can thicken. The tendon itself often thickens or grows larger.
The tendon in these late stages is often dark red in color due to the inflammation. Occasionally, the damage to the tendon can result in a tendon tear, and then deformity of the arm (a "Popeye" bulge in the upper arm).
The tendon may also become unstable and shift in and out of the groove in which it usually resides. This instability of the tendon itself can be very painful and cause a popping sensation in the front part of the shoulder.
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Cause
In most cases, damage to the biceps tendon is due to a lifetime of overhead activities. As we age, our tendons slowly weaken with everyday wear and tear. This degeneration can be worsened by overuse — repeating the same shoulder motions again and again.
Swimming, tennis, and baseball are some sports examples of repetitive overhead activities. Many jobs and routine chores can cause overuse damage as well.
Repetitive overhead motion plays a part in other shoulder problems that occur with biceps tendonitis. Rotator cuff tears, osteoarthritis, and chronic shoulder instability are often caused by overuse.
In most cases, damage to the biceps tendon is due to a lifetime of overhead activities. As we age, our tendons slowly weaken with everyday wear and tear. This degeneration can be worsened by overuse — repeating the same shoulder motions again and again.
Swimming, tennis, and baseball are some sports examples of repetitive overhead activities. Many jobs and routine chores can cause overuse damage as well.
Repetitive overhead motion plays a part in other shoulder problems that occur with biceps tendonitis. Rotator cuff tears, osteoarthritis, and chronic shoulder instability are often caused by overuse.
Symptoms
- Pain or tenderness in the front of the shoulder, which worsens with overhead lifting or activity (anterior shoulder pain)
- Pain or achiness that moves down the upper arm bone
- An occasional snapping sound or sensation in the shoulder (snapping in the shoulder)
Doctor Examination
After discussing your symptoms and medical history, your doctor will examine your shoulder.
During the examination, your doctor will assess your shoulder for range of motion, strength, and signs of shoulder instability. In addition, he or she will perform specific physical examination tests to check the function of your biceps.
After discussing your symptoms and medical history, your doctor will examine your shoulder.
During the examination, your doctor will assess your shoulder for range of motion, strength, and signs of shoulder instability. In addition, he or she will perform specific physical examination tests to check the function of your biceps.
Investigative Tests
Other tests that may help your doctor confirm your diagnosis include:
X-rays. Although they only visualize bones, x-rays may show other problems in your shoulder joint.
Magnetic resonance imaging (MRI) and ultrasound. These studies can create better images of soft tissues like the biceps tendon.
Other tests that may help your doctor confirm your diagnosis include:
X-rays. Although they only visualize bones, x-rays may show other problems in your shoulder joint.
Magnetic resonance imaging (MRI) and ultrasound. These studies can create better images of soft tissues like the biceps tendon.
Treatment
Your orthopedic surgeon will work carefully to identify any other problems in your shoulder and treat them in addition to your tendonitis.
Nonsurgical Treatment
Biceps tendinitis is typically first treated with simple methods.
Rest. The first step toward recovery is to avoid overhead activity.
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, like 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 will restore range of motion and strengthen your shoulder.
Surgical Treatment
If your condition does not improve with nonsurgical treatment, your doctor may suggest surgery. Surgery may also be necessary if you have other shoulder problems in addition to biceps tendonitis.
Surgery for biceps tendinitis is usually performed arthroscopically. During arthroscopy, your doctor makes small incisions around
your shoulder. She then inserts a small camera and miniature instruments through the incisions. This allows your doctor to
assess the condition of the biceps tendon as well as other structures in the shoulder.
Repair. In some cases, the biceps tendon can be repaired and strengthened 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.
Depending on your situation, your surgeon may choose to do this procedure arthroscopically or through an open incision.
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
Complications are rare with these types of arthroscopic procedures. Infection, bleeding, stiffness and other problems are much less common than open surgical procedures.
Overall, complication rates are low, and complications are usually simple to correct.
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 — 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.
Surgical outcome
Most patients have good results. They typically regain full range of motion and are able to move their arms
without pain. People who play very high-demand overhead sports occasionally need to limit these activities after surgery.
This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon.