Bicep Tendonitis

What is Bicep Tendonitis?

Bicep Tendonitis is a common injury. The bicep is a two-headed muscle, meaning there are two attachments (long and short head), but one singular muscle belly. The long head attachment is commonly the culprit to biceps tendinitis.

One of the largest and most complex joints in the body is the shoulder. It is multi-jointed and multi-directional. Due to the complexity and mobility of this joint, it is at higher risk for injury than most other joints in the body.

There are 3 primary bones in the shoulder joint, the humerus (arm bone), the scapula (shoulder blade), and the clavicle (collarbone). Within this joint space, it is compact, meaning the space within the joint is narrow and tight. Muscles, tendons, and ligaments run through the narrow space of the shoulder. Due to the small space of this joint, the tissues in and around the shoulder become interdependent of one another. This means they work together functionally, but this also means when one breaks down, there is a high likelihood surrounding tissue is impacted as well.

The long head biceps (LHB) attaches to the front of the shoulder at the labrum and is housed within this compact joint space. The bicep is bi-articular, meaning it controls the motion of two joints, the shoulder and elbow. The functional purpose of the biceps is to bend the elbow and it assists with rotation of the forearm. Bicep pain occurs at the front of the shoulder and it runs down the bicep, or front of the arm, especially when the arm is extended.

What causes biceps tendinitis?

Biceps tendinitis occurs more commonly in the middle-aged, or at any age with a traumatic incident, like a fall. Quite often in the elderly, bicep tendinitis is coupled with another shoulder condition like an impingement, bursitis, or rotator cuff tear.

An injury does not have to occur to develop biceps tendinitis. Commonly, biceps tendinitis occurs from repetitive activities with overhead reaching or lifting, poor body mechanics and posture, shoulder weakness or stiffness, or simply with age related body changes.

Symptoms

If you are experiencing persistent shoulder pain for more than a few weeks, it is highly recommended you consult with your health care professional. Early diagnosis and intervention is key to a speedy recovery.

The most commonly reported symptoms for biceps tendinitis include:

  • Pain with overhead activities
  • Sensation of “catching” or “clicking”
  • Sharp pain at the front of the shoulder that commonly radiates down the arm
  • Reaching behind your back (e.g, tucking in your shirt), increases shoulder pain
  • Weakness with lifting and carrying

How is biceps tendinitis diagnosed?

Trained in differential diagnosis, a physical therapist (PT) can evaluate your shoulder to determine if biceps tendinitis is present. This condition is treatable without surgical intervention.

Your PT will perform manual muscle tests (testing for strength), range of motion (testing for full movement), and pinpoint the inflamed tissue (find the pain point) during your evaluation. By doing so, the PT will determine exactly what structures are involved, along with any muscles or tendons that may be weak or imbalanced.

As part of the PT’s investigation into your shoulder pain, he or she will also complete a medical history of the shoulder to understand what activities may be triggering your symptoms. Your PT will ask about specific job duties, hobbies, and any daily activities you perform on a regular basis.

If the first step to your care is by your physician, he or she may order an X-ray or MRI (magnetic resonance image) to look at your shoulder internally. Images are not always needed, but sometimes with severe cases, the physician may look to see if multiple factors are causing your pain. Beyond the image, your physician will also complete a full exam, including a medical history review, assess the shoulder joint, and determine a treatment plan that fits with his or his examination results.

Treatment

For acute shoulder pain, onset of pain is under 48 hours, apply ice to the shoulder for approximately 20 mins, 2-3 times per day, and repeat for 2-3 days. Consult with your healthcare provider first, but sometime over-the-counter meds can help manage pain symptoms.

Decrease exposure to activities causing pain, but don’t immobilize the joint, as that may make the shoulder more stiff and painful. Physical therapy (PT) or occupational therapy (OT) is highly recommended, especially if you are experiencing pain beyond the acute phase.

The main goal with therapy is to reduce pain and any swelling to the area, along with properly strengthen the shoulder and upper back muscles. A PT or OT will retrain muscles to improve proper movement patterns, provide instruction on appropriate exercises, and assist with returning to function.

Physical and occupational therapy is not a cookie cutter approach, which is why each client needs to be evaluated and a customized treatment created. You have a choice in your PT or OT. The best way to find a highly qualified PT or OT near you, is to visit FOTO’s website at (do we want to insert FOTO database here?). Here you will find highly qualified therapists in your area. How do we know this? It is because they all track their outcomes to the care they provide. They are focused on quality care and outcomes.

In severe cases where conservative treatment does not work, your physician may recommend an anti-inflammatory injection to help manage the pain. This is not a cure, so PT or OT is recommended in conjunction with this treatment.

In the most severe cases, surgical intervention is needed. When all other avenues to control symptoms and improve function have failed, then a surgeon will repair the shoulder through a minimally invasive procedure called tenodesis or SLAP (superior labrum anterior to posterior) lesion repair. The surgeon cuts the bicep tendon head from the labrum and reattaches it to the humerus to alleviate the pressure on the labrum and biceps tendon. Post-surgery, your arm will likely be in a sling for about 3 weeks. Time away from work depends on the severity of the condition of the shoulder and what type of work you perform. Typically, a surgical candidate will be off work on anywhere from 3-weeks up to 6-months. It is recommended you consult with your physician for return to work expectations, prior to your surgery.

During the recovery period after surgery, physical therapy is recommended. Physical or occupational therapists can help manage pain, improve range of motion, and return to activities, such as work and hobbies safely.

Next Steps

If you are experiencing shoulder pain that impacts your daily activities, such as work and hobbies, seek care from a PT or OT provider of your choice. Search for a PT or OT with the best outcomes, the best customer experience, and services that are at a competitive rate.

Most states have direct access to a physical therapist, meaning you can go directly to a physical therapist, without a physician order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.

If you are uncertain with how direct access works in your state, a good starting point would be to visit with your primary physician. He or she can establish a plan with you to ensure you are getting the health care you need.

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