Biceps Tendonitis

Overview

Inflammation of the long head of the biceps tendon also known as the upper biceps tendon is called biceps tendinitis. This strong, cord-like structure in your shoulder connects the biceps muscle to the bone in your shoulder socket. Often times, pain or weakness in the front of the shoulder are common symptoms of biceps tendinitis, especially when lifting overhead, although achiness may be felt down the entire upper arm bone. You may also hear an occasional snapping sound in the shoulder with overhead activity. In the early stages, the tendon becomes inflamed and swollen. As tendinitis develops, the tendon and the covering of the tendon (sheath) thickens and increases in size. Depending on the damage to the tendon, a deformity of the arm may develop due to a partial or complete tear. Other problems may develop from biceps tendinitis including additional tears in the shoulder area, shoulder impingement, shoulder dislocation, chronic shoulder instability, and shoulder arthritis.

Cause of Biceps Tendonitis

Causes of biceps tendonitis are typically attributed to damage to the biceps tendon due to aging while still engaging in normal activities or overuse. As we all get older, our tendons slowly weaken so that even routine chores or activities that require repetitive overhead motion can lead to biceps tendinitis. Dr. Stowell will discuss your specific symptoms and medical history and then will examine your shoulder. During his examination, he will assess your shoulder’s range of motion, strength, and any signs of shoulder instability. He will also check your biceps functionality. If necessary, Dr. Stowell may also order an X-ray, MRI, or ultrasound depending on what he determines is the best imaging test to confirm his diagnosis. Although X-rays visualize bones, they can show other problems in the area of your shoulder joint. MRI’s and ultrasounds can show soft tissue damage in greater detail.

Bicep and Shoulder Diagram

Bicep Diagram

Biceps tendonitis is caused by inflammation of the bicipital tendon.

Treatment

Dr. Stowell will conduct a thorough examination of your shoulder to identify biceps tendonitis and any other issues in your shoulder. Pain can often be relieved with rest and medication, but in severe cases, surgery may be necessary to repair the tendon. Dr. Stowell’s nonsurgical treatment of your biceps tendinitis may include the following methods:

  1. Avoid activities that cause pain.
  2. To manage swelling, apply cold packs for 20-minute increments, several times a day, not directly on the skin.
  3. Nonsteroidal anti-inflammatory drugs. Ibuprofen, aspirin, and naproxen can reduce pain and swelling.
  4. Steroid injections. Cortisone is a steroid that can be injected and very effective in relieving pain.
  5. Physical therapy. Restoring your range of motion and building strength back in your shoulder will be key components to your physical therapy.

If nonsurgical treatment does not result in improvement of your condition, surgery may be the next option. Typically, Dr. Stowell will use an arthroscope for biceps tendinitis surgery. During arthroscopy, Dr. Stowell inserts a small camera called an arthroscope into your shoulder joint. It reveals images onto a television, which he uses to then guide his small surgical instruments for your surgery. There are three types of surgical repair that Dr. Stowell can perform during arthroscopy: 1) repair 2) biceps tenodesis or 3) tenotomy. Surgical complication rates are low; however, infection, bleeding, and stiffness may result. Most patients have good results after surgery, regaining full range of motion without pain. Dr. Stowell will prescribe a rehabilitation plan based on his surgical procedures. A sling may need to be worn for a few weeks to protect the tendon repair. More restricted activity following surgery is recommended to allow the tendon to heal properly. Therapeutic and flexibility exercises will help improve the range of motion in your shoulder, while strengthening exercises will also benefit your rehabilitation.

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