Introduction
Biceps tendonitis, also called bicipital tendonitis, is inflammation in the main tendon that attaches the top of the biceps muscle to the shoulder. The most common cause is overuse from certain types of work or sports activities. Biceps tendonitis may develop gradually from the effects of wear and tear, or it can happen suddenly from a direct injury. The tendon may also become inflamed in response to other problems in the shoulder, such as rotator cuff tears, impingement, or instability (described below).
Anatomy
The biceps muscle goes from the shoulder to the elbow on the front of the upper arm. Two separate tendons (tendons attach muscles to bones) connect the upper part of the biceps muscle to the shoulder. The upper two tendons of the biceps are called the proximal biceps tendons, because they are closer to the top of the arm.
The main proximal tendon is the long head of the biceps. It connects the biceps muscle to the top of the shoulder socket, the glenoid. It also blends with the cartilage rim around the glenoid, the labrum. The labrum is a rim of soft tissue that turns the flat surface of the glenoid into a deeper socket. This arrangement improves the fit of the ball that fits in the socket, the humeral head.
Beginning at the top of the glenoid, the tendon of the long head of the biceps runs in front of the humeral head. The tendon passes within the bicipital groove of the humerus and is held in place by the transverse humeral ligament. This arrangement keeps the humeral head from sliding too far up or forward within the glenoid.
The short head of the biceps connects on the coracoid process of the scapula (shoulder blade). The coracoid process is a small bony knob just in from the front of the shoulder. The lower biceps tendon is called the distal biceps tendon. The word distal means the tendon is further down the arm. The lower part of the biceps muscle connects to the elbow by this tendon. The muscles forming the short and long heads of the biceps stay separate until just above the elbow, where they unite and connect to the distal biceps tendon.
Tendons are made up of strands of a material called collagen. The collagen strands are lined up in bundles next to each other. Because the collagen strands in tendons are lined up, tendons have high tensile strength. This means they can withstand high forces that pull on both ends of the tendon. When muscles work, they pull on one end of the tendon. The other end of the tendon pulls on the bone, causing the bone to move.
Contracting the biceps muscle can bend the elbow upward. The biceps can also help flex the shoulder, lifting the arm up, a movement called flexion. And the muscle can rotate, or twist, the forearm in a way that points the palm of the hand up. This movement is called supination, which positions the hand as if you were holding a tray.
Causes
Continuous or repetitive shoulder actions can cause overuse of the biceps tendon. Damaged cells within the tendon don’t have time to recuperate. The cells are unable to repair themselves, leading to tendonitis. This is common in sport or work activities that require frequent and repeated use of the arm, especially when the arm motions are performed overhead. Athletes who throw, swim, or swing a racquet or club are at greatest risk.
Years of shoulder wear and tear can cause the biceps tendon to become inflamed. Examination of the tissues in these cases commonly shows signs of degeneration. Degeneration in a tendon causes a loss of the normal arrangement of the collagen fibers that join together to form the tendon. Some of the individual strands of the tendon become jumbled due to the degeneration, other fibers break, and the tendon loses strength. When this happens in the biceps tendon, inflammation, or even a rupture of the biceps tendon, may occur.
Biceps tendonitis can happen from a direct injury, such as a fall onto the top of the shoulder. A torn transverse humeral ligament can also lead to biceps tendonitis. (As mentioned earlier, the transverse humeral ligament holds the biceps tendon within the bicipital groove near the top of the humerus.) If this ligament is torn, the biceps tendon is free to jump or slip out of the groove, irritating and eventually inflaming the biceps tendon.
Biceps tendonitis sometimes occurs in response to other shoulder problems, including
- rotator cuff tears
- shoulder impingement
- shoulder instability
Rotator Cuff Tears
Aging adults with rotator cuff tears also commonly end up with biceps tendonitis. When the rotator cuff is torn, the humeral head is free to move too far up and forward in the shoulder socket and can impact the biceps tendon. The damage may begin to weaken the biceps tendon and cause it to become inflamed.
Shoulder Impingement
In shoulder impingement, the soft tissues between the humeral head and the top of the shoulder blade (acromion) get pinched or squeezed with certain arm movements.
Shoulder Instability
Conditions that allow too much movement of the ball within the socket create shoulder instability. When extreme shoulder motions are frequently repeated, such as with throwing or swimming, the soft tissues supporting the ball and socket can eventually get stretched out.
The labrum (the cartilage rim that deepens the glenoid, or shoulder socket) may begin to pull away from its attachment to the glenoid. A shoulder dislocation can also cause the labrum to tear. When the labrum is torn, the humeral head may begin to slip up and forward within the socket. The added movement of the ball within the socket (instability) can cause damage to the nearby biceps tendon, leading to secondary biceps tendonitis.
Symptoms
Patients generally report the feeling of a deep ache directly in the front and top of the shoulder. The ache may spread down into the main part of the biceps muscle. Pain is usually made worse with overhead activities. Resting the shoulder generally eases pain.
The arm may feel weak with attempts to bend the elbow or when twisting the forearm into supination (palm up). A catching or slipping sensation felt near the top of the biceps muscle may suggest a tear of the transverse humeral ligament.
Diagnosis
Your doctor will first take a detailed medical history. You will need to answer questions about your shoulder, if you feel pain or weakness, and how this is affecting your regular activities. You’ll also be asked about past shoulder pain or injuries.
The physical exam is often most helpful in diagnosing biceps tendonitis. Your doctor may position your arm to see which movements are painful or weak. Available arm motion is checked. And by feeling the biceps tendon, the doctor can tell if the tendon is tender.
Special tests are done to see if nearby structures are causing problems, such as a tear in the labrum or in the transverse humeral ligament. The doctor checks the shoulder for impingement, instability, or rotator cuff problems.
X-rays are generally not needed right away. They may be ordered if the shoulder hasn’t gotten better with treatment. An X-ray can show if there are bone spurs or calcium deposits near the tendon. X-rays can also show if there are other problems, such as a fracture. Plain X-rays do not show soft tissues like tendons and will not show a biceps tendonitis.
When the shoulder isn’t responding to treatment, magnetic resonance imaging (MRI) scan may also be ordered. An MRI is a special imaging test that uses magnetic waves to create pictures of the shoulder in slices. This test can tell if there are problems in the rotator cuff or labrum.
Arthroscopy is an invasive way to evaluate shoulder pain that isn’t going away. It is not used to first evaluate biceps tendonitis. It may be used for ongoing shoulder problems that haven’t been found in an X-ray or MRI scan. The surgeon uses an arthroscope to see inside the joint. The arthroscope is a thin instrument that has a tiny camera on the end. It can show if there are problems with the rotator cuff, the labrum, or the portion of the biceps tendon that is inside the shoulder joint.
Nonsurgical Treatment
Whenever possible, doctors treat biceps tendonitis without surgery. Treatment usually begins by resting the sore shoulder. The sport or activity that led to the problem is avoided. Resting the shoulder relieves pain and calms inflammation.
Anti-inflammatory medicine may be prescribed to ease pain and to help patients return to normal activity. These medications include common over-the-counter drugs such as ibuprofen.
Doctors may have their patients work with a physical or occupational therapist. Therapists apply treatments to reduce pain and inflammation. When present, conditions causing the biceps tendonitis are also addressed. For example, shoulder impingement may require specialized hands-on joint mobilization, along with strengthening of the rotator cuff and shoulder blade muscles. Treating the main cause will normally get rid of the biceps tendonitis. When needed, therapists also evaluate the way you do your work or sport activities to reduce problems of overuse.
In rare instances, an injection of cortisone may be used to try to control pain. Cortisone is a very powerful steroid. However, cortisone is used very sparingly because it can weaken the biceps tendon, and possibly cause it to rupture.
Nonsurgical Rehabilitation
You will need to avoid heavy arm activity for three to four weeks. As the pain resolves, you should be safe to begin doing more normal activities.
Your doctor may prescribe a carefully progressed rehabilitation program under the supervision of a physical or occupational therapist. This could involve four to six weeks of therapy. At first, treatments are used to calm inflammation and to improve shoulder range of motion. As symptoms ease, specific exercises are used to strengthen the biceps muscle, as well as the rotator cuff and scapular muscles. Overhead athletes are shown ways to safely resume their sport.
Source: www.eorthopod.com
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FAQs
What doctor do I see for bicep pain? ›
Orthopedic specialist or orthopedic surgeon—These specialists diagnose and treat problems of the musculoskeletal system, including joints, bones, tendons, muscles and nerves. Consider seeing a doctor who specializes in the upper extremity.
Does acupuncture help bicep tendonitis? ›It is extremely effective for the treatment of tendonitis and can help speed up the recovery time. Acupuncture utilizes sterile single-use fine needles to facilitate blood flow and fibroblastic activity within the tendon structure (where blood flow is generally limited).
How do you get rid of severe bicep pain? ›- Rest.
- A break from the sport or activity that caused the problem.
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Physical therapy and exercises.
- Cortisone injections.
- Platelet rich plasma.
For people suffering from tendonitis, it can help with pain relief and speed up the recovery process. Since tendonitis can take weeks to heal, using a massage therapy program to both relax and strengthen the inflamed tendon can give the sufferer a better chance of a full and speedy recovery.
Why is my bicep hurting so much? ›Common causes of pain in the middle of the bicep include muscle strain, bruises, and DOMS after exercise. Mild injuries usually get better on their own, while more severe ones may require medical treatment and physical therapy. Sometimes, pain in the left arm can indicate a heart attack.
What causes severe bicep pain? ›Bicep pain can have many different causes. These include biceps tendinitis, brachial plexus injury, and fractures. Symptoms include pain in the upper arm and elbow area and sometimes can radiate to the forearm. Some people experience swelling or limited movement.
Why won't my bicep tendonitis go away? ›Because it's probably tendinosis. Often, chronic tendonitis (also spelled tendinitis), which lasts more than 6 weeks is really tendinosis (also spelled tendonosis).
How long does it take for an inflamed bicep tendon to heal? ›Proximal biceps tendonitis usually heals well in 6 weeks to a few months and doesn't cause any long-term problems. It's important to rest, stretch, and rehabilitate the arm and shoulder long enough to let it heal fully. A slow return to activities and sports can help prevent the tendonitis from coming back.
What happens if you dont treat bicep tendonitis? ›If tendonitis is left untreated, you could develop chronic tendonitis, a tendon rupture (a complete tear of the tendon), or tendonosis (which is degenerative). Chronic tendonitis can cause the tendon to degenerate and weaken over time.
How do you fix nerve pain in your bicep? ›- Rest. It's important to rest your arm as much as possible to allow it to heal.
- Over-the-counter pain medication. ...
- Heat or ice. ...
- Splint. ...
- Corticosteroid injection. ...
- Surgery.
How do you calm bicep tendonitis? ›
The most important thing you can do for biceps tendonitis is to take it easy. If you feel discomfort or pain during any exercise for your tendonitis, stop and rest. You can use ice and standard pain relievers to reduce swelling and soreness.
How do you loosen a tight bicep tendon? ›Biceps stretch
Gently bend your wrist back so that your fingers point down toward the floor. You may also do this next to a wall and rest your fingers on the wall. For more of a stretch, bend your head to the opposite side of your affected arm. Hold for 15 to 30 seconds.
Tendonitis occurs because of inflammation and irritation of a tendon and often responds very well to chiropractic treatment. Chiropractic treatment is a natural way of reducing inflammation and relieving pain if you suffer from tendonitis (often spelled tendinitis).
How serious is biceps tendonitis? ›Although biceps tendonitis can be painful, if properly treated early it can usually be resolved completely. Cold packs or ice will reduce swelling and pain caused by tendonitis. Nonsteroidal anti-inflammatory medications such as aspirin or ibuprofen will help relieve swelling and pain.
What does tendonitis in the bicep feel like? ›According the American Academy of Orthopaedic Surgeons, the common symptoms of biceps tendonitis include: Pain or tenderness in the front of the shoulder, which worsens with overhead lifting or activity. Pain or achiness that moves down the upper arm bone. An occasional snapping sound or sensation in the shoulder.
When should I worry about bicep pain? ›The symptoms of biceps tendinitis may be similar to other, more severe conditions. See a doctor if you have: Pain that doesn't go away with rest or after using over the counter non-steroidal anti-inflammatory medicines (NSAIDs), such as aspirin, ibuprofen, or naproxen. Pain that gets worse over time.
Why does the front of my bicep hurt? ›Biceps tendinitis is an inflammation or irritation of the upper biceps tendon. Also called the long head of the biceps tendon, this strong, cord-like structure connects the biceps muscle to the bone in the shoulder socket. Pain in the front of the shoulder and weakness are common symptoms of biceps tendinitis.
Is heat good for bicep tendonitis? ›Heat may be more helpful for chronic tendon pain, often called tendinopathy or tendinosis. Heat can increase blood flow, which may help promote healing of the tendon. Heat also relaxes muscles, which can relieve pain.
Will a cortisone shot help bicep tendonitis? ›Non-operative treatments including corticosteroid injections are effective for the treatment of biceps tendon issues. Zhang et al, 2011, showed that 80% of patients had significant pain relief following injection into biceps tendon sheath using ultrasound guidance.
Can I use a TENS unit on my bicep? ›Where to Place Electrodes for the Biceps for TENS and Muscle Stimulation. You'll only need to use two Compex® electrodes on the bicep. Before placing the Compex® electrodes, choose the best-sized electrode for your bicep. The size of your bicep will determine the size of the electrode.
How long does it take for a bicep tendon to heal without surgery? ›
You may be able to do easier daily activities in 2 to 3 weeks, as long as you don't use your injured arm. Most people who work at a desk job can return to work in 1 to 2 weeks. If you lift, push, or pull at work, it may take 3 to 4 months or longer before you can go back to work.
What causes an inflamed bicep tendon? ›Tendonitis occurs most commonly in the long head of the biceps tendon. A debate persists regarding the role of the long head of the biceps in the function of the shoulder. Inflammation is caused by micro tears in the tendon generated by overuse or exceeding the strength of the tendon.
What exercises should I avoid with bicep tendonitis? ›If any exercise increases your pain, stop doing it. Avoid overhead lifting while your tendon is healing.
How do you know if your bicep tendon is torn? ›...
Symptoms of bicep tear or strain
- Weakness in the shoulder.
- Bruising on the upper arm.
- Inability to move or rotate your arm.
- Change in the look of the bicep in the upper arm (it may look popped out)
- Muscle spasms.
Pain from biceps tendinitis usually worsens at night, especially if the patient sleeps on the affected shoulder. Repetitive overhead arm motion, pulling, or lifting may also initiate or exacerbate the pain. The pain is most noticeable in the follow-through of a throwing motion.
Does tendonitis show up on MRI? ›Since MRI scans depend on the water or fluid content in the body tissue, you can see swelling and inflammation on these images. For instance, tendonitis will show up on an MR scan because there's usually fluid and swelling that goes along with it.
Why does bicep tendonitis hurt more at night? ›For those with tendonitis, a variety of factors can cause more pain at night, including decreased blood flow to the area, effects of gravity, and overuse during the day.
What nerve root affects the biceps? ›The musculocutaneous nerve (C5-7) is a terminal branch of the lateral cord. The musculocutaneous nerve innervates the three muscles of the anterior compartment of the arm: the coracobrachialis, biceps brachii, and brachialis muscles.
Can a pinched nerve cause bicep pain? ›The compressed nerve causes sensations such as pain, tingling, numbness or weakness and can even affect the nerve's ability to control muscles. Pinched nerves can happen throughout your body, though one of the most common places is in the spine which can cause arm tingling or pain that runs up and down your arm.
What does a pinched nerve feel like bicep? ›Pinched nerve signs and symptoms include: Numbness or decreased sensation in the area supplied by the nerve. Sharp, aching or burning pain, which may radiate outward. Tingling, pins and needles sensations (paresthesia)
How should I sleep with bicep tendonitis? ›
Sleeping on your back is best. If you're a side sleeper, sleep on the side that's not painful. Adding extra pillows around your body can help you maintain your position while you sleep. If you're a stomach sleeper, put a thin pillow under your hips to keep your spine straight while you sleep.
Do compression sleeves help bicep tendonitis? ›FAQs on biceps tendinitis
In general, compression is recommended to help ease the soreness and pain of tendinitis and other injuries. A compression sleeve, or other methods of compression therapy, is part of the standard recommendations for healing.
Most cases can be treated successfully in about four to six weeks. Your condition may take a bit longer if it is severe, or it may be a distant memory in only a few weeks of treatment. Talk with your PT about how long your specific condition is expected to last.
How can I make bicep tendonitis heal faster? ›- Rest. Rest is vital to healing tendon injuries. ...
- Nonsteroidal anti-inflammatory drugs (NSAIDs) ...
- Ice. ...
- Physical therapy. ...
- Pendulum stretches. ...
- Wall walks. ...
- Steroid injections. ...
- Non-surgical treatments.
There are distinct symptoms of biceps tendinopathy and a few provocative maneuvers can help make the diagnosis. Imaging studies (eg, MRI) can show changes in signal sequence or tears. However, MRI has a low sensitivity and frequently results in missed or misdiagnosed biceps pathology.
What kind of doctor treats muscle pain? ›Specialists who can treat muscle pain, depending on its cause, include: Physiatrists, also known as a physical medicine or rehabilitation doctors. Orthopedic specialists, medical doctors (MDs) trained to treat musculoskeletal conditions, especially surgically.
When should I see a doctor for bicep tendonitis? ›The symptoms of biceps tendinitis may be similar to other, more severe conditions. See a doctor if you have: Pain that doesn't go away with rest or after using over the counter non-steroidal anti-inflammatory medicines (NSAIDs), such as aspirin, ibuprofen, or naproxen. Pain that gets worse over time.
What kind of doctor do I see for a pulled muscle in my arm? ›While you may initially consult your family physician, he or she may refer you to a doctor who specializes in sports medicine or orthopedic surgery.
Who is the best person to see for muscle pain? ›If you have muscle pain as the result of an injury or condition, or even if you have no idea how it started, schedule an appointment with an orthopedic physician at the Center for Orthopaedic Surgery and Sports Medicine.
What not to say to your pain management doctor? ›- Don't label patients. ...
- Don't tell patients the pain is 'in our heads. ...
- Don't tell us to just 'live with the pain.
What causes constant muscle pain? ›
The most common causes of muscle pain are tension, stress, overuse and minor injuries.
Why won t my bicep tendonitis go away? ›Because it's probably tendinosis. Often, chronic tendonitis (also spelled tendinitis), which lasts more than 6 weeks is really tendinosis (also spelled tendonosis).
What happens if you ignore bicep tendonitis? ›Getting a diagnosis of tendonitis is important. A nagging pain and weakness may feel like something you can ignore and “push through,” but know that biceps tendonitis, if it progresses to frays and a more significant breakdown of tissue, can lead to a partial or full rupture of the biceps tendon.
What happens if bicep tendonitis is not treated? ›If tendonitis is left untreated, you could develop chronic tendonitis, a tendon rupture (a complete tear of the tendon), or tendonosis (which is degenerative). Chronic tendonitis can cause the tendon to degenerate and weaken over time.
How do you know if arm pain is serious? ›- Arm, shoulder or back pain that comes on suddenly, is unusually severe, or is accompanied by pressure, fullness or squeezing in your chest (this may signal a heart attack)
- An obvious deformity or protruding bone in your arm or wrist, especially if you have bleeding or other injuries.
- Weakness in the shoulder.
- Bruising on the upper arm.
- Inability to move or rotate your arm.
- Change in the look of the bicep in the upper arm (it may look popped out)
- Muscle spasms.
Signs and symptoms will vary, depending on the severity of the injury, and may include: Pain or tenderness. Redness or bruising. Limited motion.
Can a chiropractor help with bicep tendonitis? ›Tendonitis occurs because of inflammation and irritation of a tendon and often responds very well to chiropractic treatment. Chiropractic treatment is a natural way of reducing inflammation and relieving pain if you suffer from tendonitis (often spelled tendinitis).
Is a compression sleeve good for bicep tendonitis? ›FAQs on biceps tendinitis
In general, compression is recommended to help ease the soreness and pain of tendinitis and other injuries. A compression sleeve, or other methods of compression therapy, is part of the standard recommendations for healing.