Bicipital Tendinitis (Biceps Tendinitis / Shoulder
Bicipital tendinitis, referred to also as biceps tendinitis and shoulder tendinitis, is swelling of the long head of the biceps tendon. The biceps is a muscle located at the front of your upper arm, and it helps the elbow flex (bend). Tendons attach muscle to bone.
The shoulder is a ball and socket joint. A variety of tendons and muscles keeps the arm in the shoulder socket. The rotator cuff provides strength and stability to the glenohumeral joint (a ball and socket joint, also referred to as the shoulder joint) and consists of four muscles the subscapularis, the supraspinus, the infraspinus and the teres minor. All of these muscles encompass this joint and help to control the joint during rotation. The glenohumeral joint is where the humerus (bone in upper arm) attaches to the scapula (shoulder blade). The biceps muscle has two tendons (long head and short head) that attach to the shoulder; the long head inserts into the glenoid and the short head attaches to the coracoid process (a bump on the shoulder blade). The biceps tendon is exposed at the front of the shoulder as it goes through the humeral bicipital groove (intertubercular groove) and attaches to the superior glenoid tubercle of the scapula.
Biciptal tendinitis is a typical overuse sports injury and is common amongst athletes who perform an action that places strain on the shoulder. For example swimmers, tennis players, rowers, golfers, anyone who lifts heavy objects regularly, such as weight lifters. If the injury is work related it might be necessary to adjust working practices to avoid aggravating the injury further.
An increase in frequency and intensity of training.
Repetitive action, such as throwing, lifting.
Inadequate warm-up and stretching.
Poor flexibility and tight muscles.
Weak core muscles.
The shoulder can be stiff after exercise. Inflammation, redness and soreness can be felt and seen at the front of the shoulder, at the point where the long head of the biceps tendon inserts into the glenoid (the shoulder socket).
Pain is worse with activity and can be sore at night. Pain can be felt when resistance is placed against the shoulder as it flexes (bends), and when the shoulder is turned inwards.
During flexion and extension creaking can be felt at the front of the shoulder.
A positive result for the Yergason’s and the Speed’s test indicates biceps tendinitis. For the Yergason test the elbow is bent at 90 degrees and the forearm is pronated (turned and faced down). Resistance is placed against the forearm as it tries to turn to face up (supine position). If pain is felt in the bicipital groove during this action, a positive test is confirmed and suggests a tear to the long head of the biceps. In the Speeds Test the elbow is straightened and the forearm faces upwards. Pressure is placed on the forearm as it rises upwards until 60 degrees. A positive test is confirmed, if pain is felt in the area surrounding the biceps groove.
Rest; exercise should be increased gradually following a well-structured exercise plan.
Ice can help ease pain and inflammation (particularly in the case of rotator cuff tears). For the first 48-72 hours, ice packs can be administered for 10-15 minutes, every 2-3 hours. Ice stick, is another form of ice therapy, use it to massage the specific area of swelling and pain. As an ice stick is more intense, it can be applied for 5-10 minutes every 2-3 hours.
Ice treatment can be continued through the sub- acute stage (3 days-3 weeks); frequency can be reduced according to recovery, and can be continued for as long as deemed necessary.
In the sub-acute stage heat therapy can be applied.
NSAIDS (anti-inflammatories} or paracetamol may be necessary. Medical advice should be sought first before administering (in case of possible side effects).
In certain cases doctors might advise Steroid Injections for pain relief.
Physiotherapy can help by giving flexibility and strengthening exercises in the sub acute and chronic stage of healing. Sports massage is an effective form of treatment and can aid repair in the sub acute and chronic stage, by improving circulating, breaking down scar tissue, improving mobility, and stretching the tendons and muscles.
Massage should not be administered during the acute stage. If there is any underlying medical condition, such as a heart condition, it is important to seek medical advice before receiving massage.
It is important that the shoulder is not allowed to stiffen up, and should be kept mobile; however it is important that any exercise that involves repeated movement of the shoulder should be avoided, and an exercise rehabilitation programme followed. A physiotherapist or Sports massage Therapist can advise on the appropriate joint mobility, strengthening and flexibility exercises.
Resistance bands are good for the early stages of strengthening. For example, a biceps curl can be performed initially without any equipment, as the biceps gets stronger a resistance band can be introduced, followed by dumbbells. The strength and weight can be adjusting according to the individual.
Bicipital tendinitis can reoccur. It is therefore important, once full recovery has been made that a warm up is carried out before exercise.
If treatment of biceps tendinitis is delayed or ineffective it can result in a condition called ‘Frozen Shoulder’. This is because, to avoid the pain, the patient becomes more cautious about using the shoulder. The shoulder then gradually stiffens up, and becomes frozen.
Sophia Cross, BA (Hons) MA