Biceps Tendinitis

Long head of biceps tendinitis (or tendonitis) is inflammation or irritation of the upper biceps tendon. The biceps tendon is a strong, cord-like structure connecting the upper end of the biceps muscle to the bones in the shoulder. Pain in the front of the shoulder and weakness are common symptoms of biceps tendinitis. Rest and medication often help relieve these symptoms. In some cases, surgery is necessary to treat this condition.

Your shoulder is a ball-and-socket joint made up of three bones: your humerus (upper arm bone), your clavicle (collarbone), and your scapula (shoulder blade). The ball or humeral head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps your arm centered in your shoulder socket. These tissues are called the rotator cuff. They cover the head of your humerus and attach it to your shoulder blade.

The biceps muscle is in the front of your upper arm. It helps you bend your elbow and rotate your forearm. It also helps keep your shoulder stable.

The biceps muscle has two tendons that attach it to bones in the shoulder. The long head attaches to the top of the shoulder socket (glenoid). The glenoid is lined with soft cartilage called the labrum. This tissue helps the head of the upper arm fit into the shoulder socket. The short head of the biceps tendon attaches to a bump on the front of the shoulder blade called the coracoid process.

Biceps tendinitis is inflammation of the long head of the biceps tendon.

Biceps tendinitis frequently occurs along with other shoulder problems. In many cases, there is also damage to the rotator cuff tendon. Other problems that often accompany biceps tendinitis include:

• Arthritis of the shoulder joint
• Tears in the glenoid labrum
• Chronic shoulder instability
• Shoulder impingement
• Other diseases that cause inflammation of the shoulder joint lining

In the early stages of biceps tendinitis, the tendon becomes red and swollen. As tendinitis develops, the tendon sheath (covering) can thicken. The tendon itself often thickens or grows larger.

The tendon in these late stages is often dark red in color and very thick due to the inflammation. Occasionally, the damage to the tendon can result in a tendon tear and then deformity of the arm (a "Popeye" bulge in the upper arm).

The tendon may also become unstable and shift in and out of the groove in which it usually resides. This instability of the tendon itself can be very painful and cause tearing/shredding of the tendon and a popping sensation in the front part of the shoulder.

In most cases, damage to the biceps tendon is due to a lifetime of overhead activities. As we age, our tendons slowly weaken with everyday wear and tear. This degeneration can be worsened by overuse — performing the same shoulder motions again and again.

Swimming, tennis, weightlifting, and baseball are some sports examples of repetitive overhead activities. Many jobs and routine chores can cause overuse damage as well.

Repetitive overhead motion plays a part in other shoulder problems that occur with biceps tendonitis. Rotator cuff tears, osteoarthritis, and chronic shoulder instability are often caused by overuse.

• Pain or tenderness in the front of the shoulder, which worsens with overhead lifting or activity (anterior shoulder pain)
• Pain or achiness that moves down the upper arm
• A snapping sound or sensation in the shoulder (snapping in the shoulder) with certain movements (usually with rotation of the shoulder)

Dr. Jurek will perform a comprehensive clinical examination to determine if you have shoulder arthritis.

History. Dr. Jurek will talk with you about your symptoms and your medical history. She will discuss your work and lifestyle activities and also your goals for your shoulder.

Physical Exam. Dr. Jurek will perform a thorough examination of your shoulder, check the range of motion and strength, and perform specific tests to make the correct diagnosis.

X-Rays. X-rays are imaging tests that create detailed pictures of dense structures, like bone. Although they do not visualize soft tissues like the biceps tendon, x-rays may show other problems in your shoulder joint.

MRI. Dr. Jurek may order an MRI (magnetic resonance imaging) of your shoulder. An MRI provides very detailed images of the soft tissue (tendons, ligaments, cartilage, and muscles) and the bone.

Biceps tendinitis is typically first treated with simple methods:

Rest. Activity modification, avoiding activities that really flare up your biceps, and relative rest may significantly improve your symptoms.

Ice. Ice your shoulder for 20 to 30 minutes two or three times a day to reduce inflammation and ease pain. See Cold Therapy Options for more information.

Nonsteroidal Anti-Inflammatory Medicines. Drugs like ibuprofen and naproxen may reduce pain and swelling. These medications may irritate the stomach lining and cause internal bleeding. They should be taken with food. Consult with your primary care doctor before taking over-the-counter NSAIDs if you have a history of ulcers or are taking blood-thinning medication.

Steroid Injections. Steroids, like cortisone, are very effective anti-inflammatory medicines. Injecting steroids into the biceps tendon sheath can relieve pain. Dr. Jurek will use this option cautiously. In rare circumstances, steroid injections can further weaken an already injured tendon, causing it to tear.

Physical Therapy. Specific stretching and strengthening exercises will restore range of motion and strengthen your shoulder, and may help relieve the pain caused by biceps tendinitis.

If your shoulder does not improve with nonsurgical treatment, Dr. Jurek may suggest surgery. Surgery may also be necessary if you have other shoulder problems in addition to biceps tendinitis.

Surgery for biceps tendinitis is usually performed part arthroscopically and part open (using a small incision to reattach the biceps). During the arthroscopy part of the surgery, Dr. Jurek makes small incisions in your shoulder. She then inserts a small camera and miniature instruments through the incisions. This allows her to assess the condition of the biceps tendon and other structures in the shoulder.

Biceps Tenodesis. In some cases, the damaged section of the biceps is removed, and the remaining tendon is reattached to the humerus. This procedure is called a biceps tenodesis. Removing the painful part of the biceps usually resolves symptoms and restores normal function.

Biceps Tenotomy. In some instances, the optimal treatment for biceps tendinitis is to release the damaged biceps tendon from its attachment without reattachment. This is called a biceps tenotomy. This option is the least invasive but may result in a Popeye bulge in the arm.

Repair. In some cases, the biceps tendon can be repaired and strengthened where it attaches to the shoulder socket (glenoid).

After surgery, Dr. Jurek will prescribe a rehabilitation plan based on the specific procedures performed. You may wear a sling for a few weeks to protect the tendon repair. If you have had a rotator cuff repair performed in addition to surgery on your biceps, you may be in a sling for 6 weeks.

You will have immediate use of your hand for daily activities — writing, using a computer, eating, or washing.

You will likely start gentle range of motion exercises right away and usually begin formal physical therapy after your first postoperative visit with Dr. Jurek 7-10 days after surgery. Exercises to strengthen your shoulder will gradually be added to your rehabilitation plan once it is safe to do so.

If you suspect you have biceps tendinitis and shoulder pain is interfering with your normal day-to-day activities, call Dr. Jurek at (206) 386-2600 to schedule a consultation. You may also request an appointment online.