What is Bicipital Tendonitis?
When the long head of the biceps tendon or the upper biceps tendon are irritated and inflamed, it is known as Biceps tendinitis or Bicipital tendonitis. Bicipital tendonitis often happens due to repetitive strain injury, overuse injury or it could be due to rotator cuff tears or complex injuries like shoulder blade impingement, etc. Often with rest and following some simple treatments can heal the inflamed tendon causing bicipital tendonitis. However, in case of severe conditions it might require surgery. Let us see the symptoms, causes, diagnosis and treatment of bicipital tendonitis.
Symptoms of Bicipital Tendonitis
- Pain in moving the upper arm is a common symptoms of bicipital tendonitis.
- Tenderness and pain in the shoulder
- Snapping sound in the shoulder
- Difficulty in lifting something, condition worsening with lifting.
- Feeling of warmth in the shoulder region
Epidemiology of Bicipital Tendonitis
Bicipital Tendonitis is common amongst athletes, especially those, who are associated with sports like tennis, cricket, baseball, weightlifting, kayaking etc. In fact, wheelchair athletes, due to excessive use of hand movements can also have inflammation of the tendons causing the condition. It is also seen in older patients, where the condition is caused by degenerative tendinosis.
Causes of Bicipital Tendonitis
Overuse, repetitive and continuous usage of the biceps tendon can cause Bicipital tendonitis. Due to overuse, damaged cells of the tendons fail to repair themselves. The lack of time to recuperate leads to inflammation and causing bicipital tendonitis. The common causes of Bicipital Tendonitis are –
- Repetitive sports activities and frequent work activities. Athletes, who swim, throw or use racquets and swing, are mostly affected by bicipital tendonitis.
- If the shoulders are torn and wearied for years and have not had the time to heal, it can lead to bicipital tendonitis.
- When the collagen arrangement of the biceps tendons is disrupted, it can lead to inflammation of the tendons.
More Complex Causes of Bicipital Tendonitis
- Injury of Transverse Humeral Ligaments Can Cause Bicipital Tendonitis: The biceps tendons are held within the bicipital groove by transverse humeral ligaments. When these ligaments are torn, the biceps tendons are slipped off or freed from the groove. This inflames and irritates the tendons causing bicipital tendonitis.
- Bicipital Tendonitis Caused Due to Rotator Cuff Tears: If the rotator cuffs are torn in some people, the humeral head moves forward and is freed from the socket of shoulder. This weakens and inflames the biceps tendons leading to tendonitis of the biceps.
- Bicipital Tendonitis Caused Due to Shoulder Impingement: When due to certain arm movements, the acromion or the top of the shoulder blade gets squeezed with the humeral head, it inflames the biceps tendons causing bicipital tendonitis.
Pathophysiology of Bicipital Tendonitis
Tendons are made up of collagen strands that are lined-up next to each other. They are very strong, because of the tensile strength of collagen that can withstand high levels of pulls and forces. These cord-like tendons attach or connect the muscles to the bones. When excess pull or pressure is enforced on the muscles, the muscles pull the ends of the tendons and thus, the bones too start to move. When these tendons are inflamed, known as bicipital tendonitis, it causes pain in the shoulder and makes the shoulder weak.
Diagnosis of Bicipital Tendonitis
- Physical Examination for Bicipital Tendonitis: The doctor will check for the symptoms and after listening to the problems and difficulties and going through the symptoms, the doctor will diagnose the stability, strength and motion condition of the shoulder.
- Imaging Tests to Diagnose Bicipital Tendonitis: To check for any bone fractures or to go through the soft tissue conditions in details, the doctor will recommend image tests like X-ray and MRI.
Treatment for Bicipital Tendonitis
- Non-Surgical Treatments for Bicipital Tendonitis: These are more common than surgical treatment for bicipital tendonitis. Non surgical treatment includes:
- Rest: This is the most effective treatment method for Bicipital Tendonitis. The lesser is the activity of the shoulders, the faster is the healing and treatment of Bicipital Tendonitis.
- Ice: Applying ice several times a day for about 20 minutes in each session will reduce swelling associated with Bicipital Tendonitis.
- NSAIDs: These are prescribed to reduce pain and swelling associated with Bicipital Tendonitis.
- Steroid injections: At times the doctor gives steroid injections to reduce pain.
- Exercises: Exercises are recommended to strengthen the tendons.
Apart From These, Some Surgical Treatments Are Also Prescribed In Some Cases.
- Surgical Treatments for Bicipital Tendonitis: Tetonomy is the surgical process in which the surgeon will remove the damaged tendon. It is not a very invasive procedure and the complications are also minimal and can be managed well.
Prevention for Bicipital Tendonitis
In order to prevent Bicipital Tendonitis from occurring, the following steps must be followed.
- Before starting a physical activity or exercise session, always warm up the muscles and stretch the body to adjust to the following sessions.
- Build the strength and flexibility of the muscles by committing to a regular workout session.
- Always maintain a proper exercise regime that is suitable for you. Ask a professional to set a training regime for you. Do not try exercises on your own, without knowing the consequences.
- Never indulge in back to back exercises. Allow enough time between different activities, so that the muscles get time to relax.
- Any activity that causes trouble, pain or discomfort must be avoided.
Bicipital Tendonitis Rehab Exercises
If you suffer from Bicipital Tendonitis, a physical therapist will be able to provide you with some rehab exercises that will relieve the pain.
- Stretching Exercises for Bicipital Tendonitis: Once the acute pain has subsided, light stretching exercises that need to be practiced are –
- Biceps Stretching
- Towel stretching
- Flexed elbow pull.
Hold the position for about 10 seconds, repeating the exercises for about 6 times. The exercise should be continued within the pain limit and if the pain worsens and causes trouble, it must be stopped at once.
- Strengthening Exercises to Treat and Prevent Bicipital Tendonitis: In most cases the cause of Bicipital Tendonitis is because the muscles are not strong enough to withstand force. The strength of the shoulder muscles and tendons must be increased with exercises such as –
- Biceps curls
- Triceps extensions
- Shoulder internal rotations
- Shoulder external rotations and rows
These exercises must be repeated 10 to 15 times each and these should be repeated for about 3 times every day.
- Activity-Specific Exercises for Bicipital Tendonitis: Continuing the stretching and strengthening exercises, you must also gradually start your physical activity specific exercises slowly. This will help you to get back to the normal life fast. However, the activities must be done within the pain limit.
The best way to keep this condition at bay is to avoid putting excessive stress to the muscles. Every activity must be done in moderation, without harassing the muscles. Warming up is a good way to avoid stretch and pull. The strength enhancing exercises must be done all the time, in order to maintain healthy muscles and tendons.
- OrthoInfo. (2021). Biceps Tendinitis https://orthoinfo.aaos.org/en/diseases–conditions/biceps-tendinitis
- American Academy of Orthopaedic Surgeons. (2020). Rotator Cuff Tears https://orthoinfo.aaos.org/en/diseases–conditions/rotator-cuff-tears/
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