What is Biceps Tendonitis?

Biceps tendonitis is an inflammation of the bicep tendon. The bicep tendon serves to attach the bicep muscle to a bone in the elbow (distal attachment) and to a bone in the shoulder (proximal attachment). The upper tendon–called the long head–is more susceptible to developing tendonitis. Overuse activities of the shoulder, particularly overhead sports and overhead work, commonly lead to inflammation of the tendon.

Overhead athletes such as tennis players, volleyball players, and swimmers commonly develop bicep tendonitis. In some cases, bicep tendonitis can eventually lead to tearing of the bicep tendon. Dr. Cunningham is a shoulder specialist at Vail Summit Orthopaedics. He is an expert at diagnosing and treating bicep tendonitis for patients in Vail, Summit County, Aspen, and Denver, CO.

How Does Biceps Tendonitis Happen?

Biceps tendonitis usually develops over a long period of time. Repetitive use of the shoulder is the most frequent contributor. Chronic inflammation in the tendon causes the tendon’s protective layer to thicken and the tendon become larger in diameter. There is degeneration of the tendon at the cellular level which causes irritation and pain.

It is not uncommon that other problems within the shoulder joint complex can contribute to biceps tendonitis. Certain conditions, such as shoulder arthritis, cause inflammation of the shoulder joint and adjoining bicep tendon. If a patient has experienced shoulder instability or shoulder dislocations, the tissue lining the outer rim of the shoulder socket, called the labrum, commonly tears and these tears can extend into the biceps tendon which attaches to the labrum.

What Does Biceps Tendonitis Feel Like?

Patients with biceps tendonitis commonly experience:

  • Tenderness to the touch over the front of the shoulder
  • Loss of strength in the shoulder
  • Pain with movement of the shoulder, upper arm and elbow
  • Worsening pain with overhead motion
  • Achiness radiating down the upper arm
  • Intermittent sensations of popping in the shoulder
  • Difficulty sleeping at night due to shoulder pain

It is important to be evaluated by an orthopedic shoulder specialist if you are experiencing these symptoms. Initially, a history would be obtained to try to better understand when the pain began, whether there was an injury, the nature of the pain, and where the pain in located. Then a physical exam should be performed. Dr. Cunningham would first palpate key areas about the shoulder to localize the pain. Shoulder range of motion would be checked followed by an assessment of rotator cuff and biceps strength. Finally, there are several specific physical exam tests that would be done to better determine the source of the pain. If a tear is suspected, then an xray and an MRI would be ordered.

What Helps Biceps Tendonitis?

If biceps tendonitis has developed, symptoms can be ameliorated with several non-surgical treatments. Rest is the first defense against further aggravation, especially avoiding repetitive overhead activities. Icing can provide pain relief and reduce inflammation. Anti-inflammatory medications can also help treat the inflammation as well as reduce pain.

In some cases, a cortisone injection or platelet rich plasma injection (PRP) is used to help relieve pain and reduce inflammation. Cortisone injections are not used repetitively, as their overuse can weaken the already compromised tendon tissue. PRP injections may also be utilized to help facilitate healing. Physical therapy is often prescribed. The goal of physical therapy is to restore full shoulder and elbow range of motion and build strength in ways that do not further aggravate the tendon inflammation. If these conservative treatments do not improve symptoms, or if a significant tear is visualized on MRI, then surgical treatment to repair the torn tendon may be recommended.

When Will Biceps Tendonitis Go Away?

With a consistent practice of the recommended treatments, many patients report notable improvement within 6 – 12 weeks. Halting the prescribed treatment plan too soon can lead to a recurrence of the inflammation and a more prolonged recovery. Unchecked, chronic tendon inflammation often leads to tendon tearing.

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Does Biceps Tendonitis Require Surgery?

Normally, biceps tendonitis can be effectively treated without surgery. However, if there is actual tearing of the bicep tendon and if a patient’s condition worsens or does not respond to non-surgical treatments, surgical treatment may be recommended. This is particularly true for patients who have other associated shoulder problems such as rotator cuff tears or labral tears. In these cases, arthroscopic shoulder surgery to repair the torn bicep tendon and address other associated problems is indicated.

In surgery, the diseased and torn portion of the bicep tendon is removed and then the healthy portion of the bicep tendon is reattached to the humerus bone back within a groove in the bone where the tendon is normally located. At the same time, any other torn tissues are also repaired arthroscopically. Due to the minimally invasive nature of this surgery, patients experience a quicker recovery. After healing from surgery and fully recovering, patients can expect full, painless shoulder range of motion, full strength, and no pain in the biceps.

Another type of biceps tendon surgery is to release the long head of the biceps tendon, which is called a tenotomy. Many shoulder surgeons do this in most of their patients with biceps tendon tears, but Dr. Cunningham reserves this procedure for older, lower demand patients as there could be some residual weakness or crampy pain in the biceps for those who do a lot of overhead work or overhead sports. This treatment also leaves the patient with a minor bulge in the arm. However, most patients can do very well with a tenotomy and have a resolution of their pain. The recovery time from tenotomy is also somewhat shorter than a biceps repair. Dr. Cunningham is a shoulder specialist at Vail Summit Orthopaedics and Neurosurgery. He is an expert at diagnosing and treating biceps tendonitis for patients in Vail, Summit County, Aspen, and Denver, CO. Contact Dr. Cunningham today.

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