Bicipital Tendonitis

Bicipital Tendonitis is an inflammation of the long head of the biceps tendon.  The biceps tendons are tough fibrous tissue attaching the biceps muscle to the shoulder.   Inflammation will usually produce pain, tenderness and stiffness near the shoulder joint. 

  As defined by the American Academy of Orthopedic Surgeons, “the biceps muscle is in the front of your upper arm.  It helps you bend your elbow and rotate your arm. It also helps keep your shoulder stable.”  Sports that heavily utilize the biceps are boxing, climbing, racquet sports, swimming, baseball/softball pitchers, football quarterbacks and rowing. 

How does bicipital tendonitis occur?

The role of the tendons is to attach muscle to bone working together to exert a pulling force.  With repetitive motion, direct trauma, overuse and/or age, our tendons lose some of their elasticity or simply don’t regenerate healthy tissue in time.  When tendonitis is present, swelling and stiffness occurs.  The tendon hardens, limiting movement and creating an opportunity for muscle or tendon tears to occur.  In chronic cases a full rupture may occur if not treated in time. 

Symptoms:

• Swelling and pain in front of the shoulder when extending the arm out to the side or bringing it overhead
• Redness, deep ache or burning sensation in the front of your shoulder
• Pain worse at the beginning or end of your day (in chronic cases – pain is felt throughout the day)
• Local point tenderness at the front of the shoulder over bicipital groove
• Occasional snapping sound or sensation in the shoulder
• Weakness when attempting to bend the elbow or when turning the forearm to a palm up position

Diagnosis:

• Visit your physical therapist or orthopedic doctor where a physical exam, X-ray or MRI may be performed if necessary
• Arthoscopy if no positive response to treatment is seen

Treatment:

• Rest and ice often.  All activities that stress the bicipital tendon should be halted to allow inflammation to dissipate and healing to occur.  This period may last 3-6 weeks depending on severity

• A sling may be in order to prevent overhead movement or extension of the arm
• NSAID’s – non-steroidal anti-inflammatory medication may be prescribed by your doctor
• Doctors may prescribe a steroid injection to reduce inflammation and pain
• Physical therapy after initial rest period with joint mobilization and strengthening program
• Massage therapy to reduce scar tissue around the tendon.  Active release and kneading is recommended
• Surgery may be necessary in a worst case scenario if non-surgical treatment is not effectiv

Resources:

For a list of exercises helpful in recovering from bicipital tendonitis view this page provided by the University of Michigan Health System.

References:

• American Academy of Orthopedic Surgeons; Tendonitis of the Long Head of the Biceps: http://orthoinfo.aaos.org/topic.cfm?topic=A00026&return_link=0
• http://www.itendonitis.com/bicep-tendonitis.html
• Canadian Orthopaedic Association
  http://www.coa-aco.org/
• Anderson, Hall, Martin, Sports Injury Management; 1^st Ed 1995; 301
• Fritz, Sandy, Sports & Exercise Massage 2005; 465