Biceps Tendonitis: Causes, Symptoms, and Treatment

What is Biceps Tendonitis?

The biceps tendon is a thick band of tissue that connects the biceps muscle to the bones of the shoulder (the long headof the biceps tendon) and elbow (the short head). Biceps tendonitis occurs when this tendon becomes inflamed, usually due to overuse, injury, or aging. The condition typically affects the long head of the biceps tendon, which is the one most commonly involved in shoulder-related tendonitis.

Causes of Biceps Tendonitis

Biceps tendonitis can develop from various causes, including:

• Repetitive Overhead Movements: Activities like throwing, swimming, or weightlifting that involve repetitive overhead motions can place excessive stress on the biceps tendon, leading to inflammation.

• Aging and Degeneration: As we age, tendons naturally weaken, becoming more prone to irritation and injury. This is especially common in people over 40.

• Shoulder Impingement: Shoulder impingement occurs when the tendons of the rotator cuff, including the biceps tendon, are compressed between the bones of the shoulder joint. This increased friction can cause tendonitis.

• Overuse or Strain: Sudden or excessive use of the arm, particularly in activities that involve heavy lifting or pulling motions, can strain the biceps tendon and cause inflammation.

• Trauma or Injury: A direct blow or injury to the shoulder or elbow can cause inflammation in the biceps tendon.

• Muscle Imbalances: Weakness in the shoulder muscles or the rotator cuff can lead to abnormal movement patterns, which may contribute to tendonitis.

Symptoms of Biceps Tendonitis

The most common symptoms of biceps tendonitis include:

• Pain in the Front of the Shoulder: The pain is typically felt in the front or outside of the shoulder, where the biceps tendon attaches. The pain may worsen with overhead activities or lifting.

• Pain when Lifting or Reaching: Pain may intensify when reaching overhead, lifting objects, or performing other activities that stress the shoulder.

• Tenderness and Swelling: The area over the tendon may be tender to the touch, and swelling may develop, particularly if there is an acute injury.

• Weakness: Weakness in the shoulder or elbow, especially during movements that require lifting or pulling, may be present.

• Limited Range of Motion: Due to pain and inflammation, it may be difficult to move the shoulder or elbow through its full range of motion.

• Clicking or Popping: In some cases, individuals with biceps tendonitis may experience a clicking or popping sensation in the shoulder when moving the arm.

Diagnosing Biceps Tendonitis

A healthcare provider will diagnose biceps tendonitis through a combination of physical examination, patient history, and imaging tests:

• Physical Exam: The provider will test the shoulder for tenderness along the biceps tendon, especially when the arm is raised or rotated. Specific tests, such as the Speed's test or Yergason's test, may be used to reproduce symptoms and assess the tendon.

• Imaging Tests: While X-rays are not effective in diagnosing tendonitis, they may be used to rule out other causes of shoulder pain, such as fractures or arthritis. MRI (Magnetic Resonance Imaging) is the preferred method for diagnosing biceps tendonitis, as it provides detailed images of soft tissues, including the tendon.

Treatment for Biceps Tendonitis

Treatment for biceps tendonitis focuses on reducing inflammation, improving mobility, and strengthening the muscles surrounding the tendon. The treatment approach may include:

Non-Surgical Treatments

For most cases of biceps tendonitis, non-surgical treatment options can be effective in relieving symptoms:

• Rest and Activity Modification: Resting the shoulder and avoiding activities that aggravate the tendon, such as overhead lifting or repetitive motion, is crucial for allowing the tendon to heal.

• Ice Therapy: Applying ice to the affected area for 15-20 minutes, several times a day, can help reduce pain and swelling.

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter NSAIDs like ibuprofen or naproxen can be used to reduce pain and inflammation in the tendon.

• Physical Therapy: A physical therapist will design a rehabilitation program that focuses on improving shoulder mobility, strengthening the rotator cuff muscles, and correcting muscle imbalances. Specific exercises may target the biceps tendon and other muscles that support the shoulder joint.

• Corticosteroid Injections: In cases of severe inflammation, a corticosteroid injection may be recommended to reduce pain and swelling in the tendon. However, injections are typically used sparingly to avoid potential weakening of the tendon over time.

• Ultrasound Therapy: Therapeutic ultrasound may be used by physiotherapists to promote healing, reduce inflammation, and stimulate blood flow to the affected area.

Surgical Treatment

If conservative treatments do not provide relief or if the biceps tendon is severely damaged, surgery may be required. Surgical options include:

• Biceps Tendon Repair: If the tendon is severely torn or ruptured, surgery may be performed to reattach the tendon to the bone. This is typically done through minimally invasive arthroscopic surgery.

• Biceps Tenodesis: If the tendon is chronically damaged or if there is a need to address long-term instability, a procedure called biceps tenodesis may be performed. This involves reattaching the biceps tendon to a different part of the upper arm bone (humerus) to relieve tension on the shoulder.

• Arthroscopic Debridement: If the tendonitis is caused by wear and tear or degenerative changes, the surgeon may remove any damaged or inflamed tissue from the tendon through an arthroscopic procedure.

Rehabilitation and Recovery

Recovery from biceps tendonitis involves a gradual rehabilitation process to restore function, strength, and flexibility to the shoulder. A typical recovery process includes:

• Phase 1: Pain Management: Initially, the focus is on managing pain and inflammation through rest, ice, and anti-inflammatory medications.

• Phase 2: Range of Motion Exercises: Once pain subsides, gentle range-of-motion exercises are introduced to restore flexibility and mobility in the shoulder.

• Phase 3: Strengthening: As healing progresses, strengthening exercises are added to build up the muscles around the shoulder and prevent re-injury.

• Phase 4: Sport-Specific Rehabilitation: Athletes may undergo sport-specific training to prepare for a return to activities that involve overhead or heavy lifting motions.

• Return to Activity: Depending on the severity of the injury, most people return to normal activities within 6 to 12 weeks, while athletes may require longer to regain full strength and function.

Prevention of Biceps Tendonitis

Preventing biceps tendonitis involves addressing the risk factors and incorporating strategies to protect the shoulder tendon:

• Proper Technique: Using proper form during physical activities, such as lifting weights or throwing, can reduce the stress placed on the biceps tendon.

• Strengthening Exercises: A balanced strength training program that focuses on the shoulder muscles, particularly the rotator cuff and scapular muscles, can help stabilize the shoulder and reduce the risk of tendonitis.

• Stretching and Warm-Up: Prior to physical activities, it is important to warm up and stretch the shoulder muscles to increase flexibility and prevent strain.

• Avoid Overuse: Repetitive overhead activities, especially those that involve heavy lifting or repetitive motions, should be done in moderation, with adequate rest periods to allow the tendon to recover.

Expert Care at Palms Physiotherapy & Allied Health

At Palms Physiotherapy & Allied Health, we offer expert physiotherapy services to help you recover from biceps tendonitis. Our team will develop a personalized treatment plan to reduce pain, improve range of motion, and restore strength to your shoulder. We can guide you through the rehabilitation process and help you return to your normal activities without discomfort.