The Biceps is the muscle on the front of your arm that bulges as you bend your elbow. Its tendons attach to the shoulder blade (scapula) and at the elbow (to the radius – a bone in in your forearm). Near its attachment to the shoulder blade, the biceps tendon runs through the top edge of the shoulder joint.
Normal wear and tear as we age results in gradual degeneration and injury in the tendon. When this becomes serious enough, the tendon becomes irritated or inflamed, resulting in tendonitis. This is more likely to occur when there are pre-existing injuries in the shoulder, particularly in the rotator cuff, or when repetitive high-stress activities have put excess strain on the tendon.
As biceps tendonitis is relatively common, there are a number of very effective treatments available to relieve pain. These may involve simple rest and pain-relief, through to intensive physiotherapy and even surgery. The choice of treatment will vary with the severity of the tendonitis and the strength and function required in the affected arm.
Symptoms
The most common symptom is pain.
Pain is generally reported at the front of the shoulder, sometimes shooting down to the elbow. It is made worse by using the shoulder, and may be relieved by rest.
Causes
Repetitive overhead activities over many years can cause biceps tendonitis. Swimming and tennis are examples, as well as some forms of manual labour. Damage to the tendons in the shoulder accumulates over many years of these activities.
Biceps tendonitis often occurs in conjunction with other conditions caused by repetitive overhead activities, such as rotator cuff tears and arthritis.
Risk Factors
Swimming, tennis, or weightlifting exercises that involve overhead work.
Manual labouring that involves overhead work.
Investigations
As part of diagnosing the source of shoulder pain, a doctor may order:
- X-ray – this gives a good picture of bony structures in and around the shoulder
- Ultrasound – this gives a picture of soft tissue structures around the shoulder joint, such as rotator cuff tendons and biceps tendons
- MRI – this gives an excellent picture of the entire biceps tendon and other soft tissues.
Complications
Biceps tendonitis usually comes together with the shoulder problems. In the majority of these cases, there is secondary damage to the tendon.
Apart from that, there is also increased risk of other problems : A
- Arthritis of the shoulder joint
- Tears in the soft-padding that fits into the socket in the shoulder joint (‘glenoid labrum’)
- Chronic shoulder instability
- Shoulder impingement
- Other diseases that cause inflammation of the shoulder joint lining
Treatment
When biceps tendonitis is first diagnosed, treatment consists of simple measures, such as:
- Rest
- Icing the affected area – this reduces inflammation in the tendon
- Anti-inflammatory medications – this reduces pain and inflammation in the tendon
- Exercises – designed to improve the range of motion of your shoulder
- Steroid injections into the tendon
Should these simple measures fail to improve the pain after 6 months, surgery is sometimes considered. The preferred surgical option is called acromioplasty, whereby a small piece of bone is removed from the shoulder using keyhole surgery (arthroscopy).
Another potential surgical option is a biceps tenodesis, where the biceps tendon is detached at the shoulder, then reattached on the arm bone (humerus).
Seeking Advice
The Physiotherapist
The physiotherapist will be able to examine your arm and suggest a diagnosis. They may also be able to provide you with:
- Pain relief
- Begin therapy
- Discuss whether you should seek a medical opinion
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
The only way to prevent biceps tendonitis is to reduce the amount of overhead activities (swimming, tennis, weightlifting, labouring) that you do.