Anatomy & Background
A tendon is part of the muscle that attaches muscle to bone. It is a strong, fibrous tissue that is responsible for transferring the forces generated by the muscle to the bone, thus producing movement at the joint. When a tendon becomes irritated or inflamed it can be painful, especially with movement. Inflammation of the tendon is called tendinitis.
Tendinitis of the shoulder typically occurs in the subacromial space and is common due to the anatomy of the shoulder coupled with stressful activity assigned to the joint. The subacromial space is an area on the top the shoulder formed by the coracoacromial arch. This arch is formed by the acromioclavicular joint, coracoacromial ligament and acromion (outer edge of the shoulder blade).
The chief tendons of the shoulder, the rotator cuff and long head of the biceps, pass under this arch. Reduction of this space exposes the tendons to a high risk for friction, rubbing and irritation, setting the stage for a case of tendinitis. Tendon problems usually emerge in individuals 40 to 60 years old but are increasingly being seen in young athletes as a byproduct of repetitive overuse.
Biceps tendinitis is the inflammation of the upper biceps tendon. Several muscles and tendons keep the arm anchored in the shoulder joint and the head of the humerus (upper arm bone) fits into the joint socket. One of these muscles is the long head of the biceps tendon that attaches to the glenoid labrum.
This tendon is responsible for bending the elbow (flexion), turning the forearm (supination) and raising the arm overhead. It is commonly irritated with repetitive overhead activities and routine lifting that may result in pain and weakness in the shoulder. Increased age can increase the potential for a rupture.
Biceps Tendinitis is most diagnosed as an overuse repetitive strain injury (RSI). Other high risk activities or conditions that can lead to the development of biceps tendinitis include:
- Participating in activities requiring overhead motions like swimming, tennis, softball and baseball.
- Repetitive strain injuries (RSI) at work are common in people performing activities habitually in nature such as assembly line work.
- Sudden injury to the region like a fall on the shoulder.
- Patients suffering from rheumatoid arthritis may have an increased risk to tendinitis.
- Aging resulting in changes to tendon elasticity and circulation that increase susceptibility to injury and reduce ability to heal.
- Postural factors like a forward head and shoulder posture reducing the subacromial space, thus leading to irritation of the shoulder tendons.
- Overload injuries derived from lifting heavy objects or weight training.
- Weakening of the rotator cuff causing a muscular imbalance resulting in shoulder impingement (pinching).
Signs and Symptoms of Biceps Tendinitis
- Pain, either acute or dull, when preforming motion and that lingers even when the shoulder is at rest.
- In more severe cases, pain that radiates to the upper arm and be accompanied by a burning sensation restricting movement.
- Tenderness and/or tightness of the area, especially to one’s touch.
- Difficulty sleeping on affected side and pain that worsens overnight.
- Reduction of ability to preform tasks essential to daily life such as difficulty dressing.
- Increased weakness and swelling of the tendon as inflammation escalates.
- Damage to the glenoid labrum, the spot where the long head of the biceps tendon attaches to the shoulder.
Treating and Managing Your Pain
At the first sign of tendinitis, you should avoid performing positions and activities that exacerbate the pain inflicted stemming from the inflammation.
Conservative treatment plans exercised under a doctors care include rest, alternating application of heat and ice to the area, physical therapy and non-steroidal medications to reduce inflammation. A pain management program may be implemented to help limit discomfort by allowing the patient to perform rehabilitation exercises.
If your symptoms persist, steroidal medication or injections may be prescribed by your health care professional to be used in tandem with therapy. Surgical intervention may be discussed to treat highly severe cases to address the cause of biceps tendinitis.
Physical Therapy Intervenes
If surgery is deemed unnecessary, treatment will focus on the restoration of shoulder motion. As the pain dissipates, strengthening exercises should be initiated to prevent muscle weakness and atrophy. Common treatment methods of a Biceps Tendinitis includes:
- Manual Therapeutic Technique (MTT) including soft tissue massage, deep friction massage and joint mobilization to regain motion range and flexibility of the shoulder.
- Therapeutic Exercises (TE) to regain range of motion and strengthen the shoulder and surrounding joints.
- Neuro-muscular re-education to begin retraining the upper extremities for use in daily activities.
- Modalities including the use of ultrasound, electrical stimulation, icing the area and cold laser to decrease pain at the shoulder.
- Home exercise program that includes stretching and strengthening exercises.
If detected and treated early, many recover full function and range of the shoulder provided the individual is dedicated to the treatment program prescribed. Those patients dealing with more involved cases, such as impingement due to bone spurs, have high success rates with surgical decompression of the area. It is hard to predict the outcome of tendon tears, as the success of rehabilitation is dependent on the size of the tear, integrity and elasticity of the tissue, the patient’s age, preoperative condition of the patient and if the patient is experiencing any comorbid syndromes. Please refer to the Rotator Cuff Tear section for more information on tendon tears.
Preventing Biceps Tendinitis
Small measures can be taken by at-risk individuals to help prevent tendinitis – it is far easier to prevent the condition than it is to treat it as some damage may be irreversible or costly to fix. Below list some tips to reduce the risk of tendinitis:
- Warm-up for athletic activity gradually. This improves circulation and lubrication to the muscle and tendon. Remember to stretch after preforming strenuous activity.
- Do not bounce when stretching. Instead, hold the stretch for 15 to 20 seconds.
- Utilize a strength-training program to improve and stabilize the muscles and tendons used for activity. A regular strength-training program three times a week will increase muscle health and help reduce weakening brought on by aging.
- Always listen to your body – do not work through pain. Avoid the “no pain, no gain” philosophy as you may inflict serious damage to yourself. Pain is the body’s way of notifying you to stop what you are doing.
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