What Is Bicipital Tenosynovitis?
In order to understand Bicipital Tenosynovitis, it is important to understand what a tendon is. A tendon is a form of a fibrous tissue which connects the muscles to bones. The tendons help the bones and muscles to perform their functions and allow an individual to do activities like running, jumping, grasping, and lifting. If the tendon in any area is affected, strained, or torn then it becomes difficult for the muscles and bones of that area to carry out their functions normally.
This tendon is covered with a protective sheath known as the synovium. This synovium produces the synovial fluid which keeps the tendon well lubricated so that it carries out its activities smoothly. Any injury to the tendons may result in malfunction of the sheath and when this occurs there may not be enough synovial fluid produced to keep the tendons lubricated which results in inflammation of the tendon sheath or what we call as tenosynovitis.
Bicipital Tenosynovitis is a pathological condition in which there is inflammation of the tendon sheaths that surround the biceps tendons. Bicipital Tenosynovitis can be a result of many small tears resulting in inflammation over a period of a number of years or due to an acute injury to the biceps region. When examining the biceps region radiologically, in cases of Bicipital Tenosynovitis there will be significant calcification of the tendon and presence of bone spurs in the intertubercular groove. The most common treatment for Bicipital Tenosynovitis is conservative treatment with physical therapy and exercises. In some cases surgery is also required to treat Bicipital Tenosynovitis.
What Are The Causes Of Bicipital Tenosynovitis?
As stated, Biceps Tenosynovitis can be caused due to many small tears which may developed over a period of number of years along the biceps tenon which when an individual reaches middle age start to act up and cause inflammation of the tendon sheath of the biceps resulting in Biceps Tenosynovitis. Apart from that any injury to the biceps tendon, muscle or the bone can also cause Biceps Tenosynovitis. This condition is quite common in athletes who participate in throwing events like Shot Put and Discus. Additionally, people who are involved in activities which involve a lot of repetitive movements of the hands and shoulders also tend to get Biceps Tenosynovitis. Some of the injuries which can result in Biceps Tenosynovitis are:
- Injuries due to repetitive motions of the arm
- Prolonged physical activities using the arm
- Using the shoulders for lifting, pushing, and pulling heavy items for prolonged periods of time
- Sudden twisting and pivoting of the arm
Some of the medical conditions that can result in Biceps Tenosynovitis are:
In some cases, a cut or a puncture wound to the biceps tendon such as being stabled by a knife or any other sharp object in the arm or shoulder area may also result in Biceps Tenosynovitis.
Who Is At Risk For Getting Bicipital Tenosynovitis?
People who are at risk for developing Biceps Tenosynovitis are:
- Data Entry Operators
- People working in the construction industry
- People working in the assembly line
What Are The Symptoms Of Bicipital Tenosynovitis?
The tendon in the biceps region is quite vulnerable to injuries as the hand is one of the busiest parts of the body and hence inflammation of the tendon sheath or tenosynovitis is quite common in this area. Some of the symptoms of Biceps Tenosynovitis are:
- Shoulder stiffness
- Difficulty moving the arm without discomfort or pain
- Swelling of the joint
- Pain around the biceps region
- Tenderness along the area of the biceps
- In some cases, there may be erythema around the skin over the biceps tendon area
- In some cases, there may be fever suggesting the presence of an infection as a cause of Biceps Tenosynovitis
How Is Bicipital Tenosynovitis Diagnosed?
For diagnosing Biceps Tenosynovitis, a detailed physical examination of the area will be conducted. The doctor will check for presence of any swelling or tenderness. The doctor may ask the patient to move the arm to see whether there is any pain with movement of the joint. The doctor will then order some radiological studies to rule out other conditions causing the symptoms such as arthritis. In infection is suspected, a laboratory study will also be ordered. Once all other conditions causing the symptoms are ruled out then diagnosis of Biceps Tenosynovitis is confirmed.
How Is Bicipital Tenosynovitis Treated?
The standard protocol for treatment for Biceps Tenosynovitis is aimed at reducing inflammation and control the swelling and pain. This is done by providing adequate rest to the area. The patient is not allowed to do any activities with the affected hand which may aggravate the condition.
Additionally, a support brace may be recommended to immobilize the area to allow the swelling and inflammation calm down. To control the swelling and pain, application of heat for 15-20 minutes two to three times a day will also be recommended.
The patient can alternatively apply ice to the affected area for calming down swelling and pain. The patient will be given pain medications in the form of NSAIDs to help with the pain.
Some of the other modalities used for treating Biceps Tenosynovitis are:
In case if Biceps Tenosynovitis is caused due to an underlying medical condition like rheumatoid arthritis or gout then the doctor will prescribe medication for treatment of this condition as well.
Once the inflammation of the tendon sheath has calmed down then the patient will be sent to a physical therapist to strengthen the biceps muscles as they would have become stiff due to immobilization.
Surgery is reserved for those individuals who have recurrent episodes of Biceps Tenosynovitis.
What Is The Prognosis Of A Bicipital Tenosynovitis?
The prognosis for Biceps Tenosynovitis is quite good with treatment and therapy, although the patient needs to be very diligent in complying with the restrictions imposed on the patient by the doctor like not using the affected hand for doing any activities. If the patient is not compliant then the inflammation may not calm down and it may result in permanent damage to the tendons. Usually it takes about a couple of weeks for the inflammation to calm down and get complete relief from Biceps Tenosynovitis.
- American Academy of Orthopaedic Surgeons. (2021). Bicipital Tendinitis https://orthoinfo.aaos.org/en/diseases–conditions/bicipital-tendinitis
- Cleveland Clinic. (2021). Biceps Tendonitis https://my.clevelandclinic.org/health/diseases/18238-biceps-tendonitis
- PubMed Central. (2015). Bicipital tenosynovitis: an overview https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4350696/