BICEPS TENDONITIS

What is biceps tendonitis?

The biceps tendon (a strong, cord-like structure) connects the biceps muscle to the bones in the shoulder. Biceps tendonitis (inflammation) is defined as irritation or damage to the biceps tendon in front of the shoulder. Biceps tendonitis usually occurs with other shoulder problems. In most cases, there is also damage to the rotator cuff tendon. Other associated problems include:

• Arthritis of the shoulder (osteo-arthritis and rheumatoid arthritis)


• Tears in the glenoid labrum or ligaments of the biceps


• Chronic shoulder instability


• Shoulder impingement


• Diseases that cause inflammation of the shoulder joint lining

In the early stages of biceps tendonitis, the tendon becomes red and swollen and as the condition worsens, the tendon often thickens. The biceps tendon in these late stages is often dark red in color due to the inflammation. The damage to the biceps tendon can result in a tendon tear, and then deformity of the arm near the biceps (aka a "Popeye" bulge in the upper arm).

Symptoms

• Pain or tenderness in the front of the shoulder. These symptoms are worsened with overhead activity


• Pain or discomfort that moves down the front of the upper arm


• Snapping or clicking sensation in the shoulder

Causes of biceps tendonitis

Biceps tendonitis and a torn biceps can be caused by various actions involving the arm and shoulder. As we get older, our tendons slowly weaken with everyday wear and tear. This degeneration can be worsened by overuse (repeating the same shoulder motions again and again). Tennis and swimming are some examples of repetitive overhead activities. Many other activities and even routine chores can cause overuse damage as well. Repetitive overhead movement plays a role in other shoulder problems that occur with biceps tendonitis. Rotator cuff tears, osteoarthritis, and chronic shoulder instability are often caused by overuse.

How is biceps tendonitis diagnosed?

During the examination, your doctor will assess your shoulder for:

• Range of Motion.


• Strength.


• Signs of shoulder instability.


• Your doctor will perform specific physical examination tests to check the function of your biceps

The following tests may be ordered during diagnosis:

• X-rays: Helps to assess bones and joints


• Ultrasound and Magnetic resonance imaging (MRI): These studies can create better images of the soft tissues around and inside the shoulder.

How is biceps tendonitis treated?

Your orthopaedic surgeon will work carefully to identify any other problems in your shoulder and treat them with your biceps tendonitis.

Nonsurgical Treatment

• Rest: Try to reduce overhead activities


• Ice packs: Apply for 20 minutes at a time, several times a day, to keep swelling down. Do not apply ice directly to the skin.


• Nonsteroidal anti-inflammatory medicines (Voltaren, Brufen, Cataflam, Coxflam, Arcoxia, Celebrex etc.) reduce pain and swelling.


• Steroid (cortisone) injections: Cortisone is a very effective anti-inflammatory medicine. Injecting steroids next to the tendon can relieve pain. Dr van den Berg will use these cautiously. In rare circumstances, steroid injections can further weaken the already injured tendon, causing it to tear.


• Physiotherapy: Specific stretching and strengthening exercises will restore range of motion and strength of your shoulder and the torn biceps.

Surgical Treatment

If your condition does not improve with proper nonsurgical treatment, your orthopaedic surgeon may suggest surgery. Surgery may also be necessary for a torn biceps or if you have other shoulder problems. Surgery for biceps tendonitis is usually performed arthroscopically (key-hole surgery) - your doctor makes small incisions around your shoulder and then inserts a small camera and miniature instruments through the incisions. This allows your doctor to assess and treat the condition of the biceps tendon as well as other structures in the shoulder.

• Repair: In many cases, the torn biceps tendon can be repaired and strengthened where it attaches to the shoulder socket.


• Biceps tenodesis: The damaged section of the biceps is removed, and the remaining tendon is reattached to the humerus. Removing the painful part of the biceps usually resolves symptoms and restores normal function. Dr van den Berg does this surgery arthroscopically.


• Tenotomy: In severe cases or in older patients, the long head of the biceps tendon may be so damaged that it is not possible to repair or tenodese it. The damaged biceps tendon is released from its attachment. This option is the least invasive but may sometimes result in a "Popeye" - bulge in the upper arm.

Most patients have good results. They typically regain full range of motion and can move their arms without pain. People who play very high-demand overhead sports occasionally need to limit these activities after surgery.

Complications are rare with arthroscopic procedures. Infection, bleeding, stiffness and other problems are much less common than seen in open surgical procedures. Overall, complication rates are low, and complications are usually simple to correct.

What to expect after surgery?

After surgery, your doctor will prescribe a rehabilitation plan based on the procedures performed. You may wear a sling for a few weeks to protect the tendon repair. You should have immediate use of your hand for daily activities — writing, using a computer, eating, or washing. Your orthopaedic surgeon may restrict certain activities to allow the repaired tendon to heal. It is important to follow your doctor's directions after surgery to avoid damage to your repaired biceps.

Your doctor will soon start you on therapeutic exercises (physiotherapy). Flexibility exercises will improve range of motion in your shoulder. Exercises to strengthen your shoulder will gradually be added.