Biceps tendinitis

Biceps tendinitis, also called biceps tendonitis, is an inflammation in the main part of the tendon that attaches the top of the biceps muscle to the shoulder. The most common cause is excessive strain during certain jobs or sports. Biceps tendinitis can also develop gradually, due to normal wear and tear or direct injury. Tendon inflammation can also occur due to other injuries in the shoulder, such as a rotator cuff injury, impingement, or instability in the shoulder.

Causes

Prolonged or repeated movements of the shoulder can place excessive stress on the biceps tendon. In such cases, the tendon tissue does not have sufficient time to regenerate, which leads to the development of tendinitis. Most often, biceps tendonitis occurs when playing certain sports or activities that require repeated overhead movements of the arm. For athletes, these are sports such as swimming and tennis. When inflammation occurs due to wear and tear, tissues show signs of degeneration. Degeneration in the tendon disrupts the normal presence of collagen fibers that form the tendon. Some tendon fibers become tangled, others tear due to degenerative processes and thus the tendon loses strength. When degenerative processes occur in the biceps tendon, inflammation of the tendon occurs, and sometimes tendon rupture can occur.

Biceps tendinitis can also occur from direct trauma, such as a fall on the top of the shoulder. Tears of the transverse brachial ligament can also lead to biceps tendinitis (the transverse brachial ligament holds the biceps tendon in the bicipital notch, located near the top of the humerus). If this ligament is torn, the biceps tendon can freely pop out of the notch and become irritated, which leads to inflammation of the biceps tendon.

Biceps tendonitis sometimes occurs due to other shoulder problems, such as:

rotator cuff tears,
shoulder impingement,
shoulder instability.

Rotator cuff tears

Age-related tears in the rotator cuff eventually lead to the development of biceps tendinitis. With a rotator cuff tear, the head of the humerus is free to move forward and upward in the shoulder socket and this has an indirect effect on the biceps tendon. Damage of this kind causes weakening of the biceps tendon and inflammation.

Shoulder impingement

In the shoulder, impingement occurs when the soft tissue between the head of the humerus and the upper part of the shoulder blade (acromion) is pinched and this occurs with certain movements of the arm.

Shoulder instability

Conditions in which there is too much movement of the humeral head in the socket cause shoulder instability to develop. Instability can also develop as a result of repeated excessive loads, for example, when swimming or throwing a ball, stretching of the soft tissues responsible for the stability of the head of the humerus in the socket.

The labrum (labrum) may begin to move away from its attachment to the articular surface. A shoulder dislocation can cause a labral tear, and when this tear occurs, the head of the humerus begins to move excessively upward and forward in the socket. An increase in the range of motion in the socket can lead to damage to the adjacent biceps tendons and then to inflammation of the biceps tendon itself.

Causes of pain in the biceps of the arms

Muscle tension

Muscle strain occurs when a muscle experiences too much pressure and the fibers inside it tear. For example, lifting an object that is too heavy or performing too many repetitions of an exercise can lead to muscle strain. Symptoms of muscle strain depend on the severity of the injury:

Grade 1: Mild tension manifests itself as muscle soreness, often the next day after intense exercise.
Grade 2: Moderate strain results in significant pain, mild swelling, and decreased muscle strength.
Grade 3: Severe tension results in severe pain and swelling, as well as complete loss of muscle function.

Treatment methods

For grade 1 and 2 muscle strains, doctors recommend:

Rest
: Rest until the pain subsides
Ice
: Using an ice pack several times a day for 20 minutes at a time will reduce swelling.
Compression
: Wrapping the muscle tightly in a bandage will also help relieve swelling.
Elevation
: Keeping the limb elevated, as close to heart level as possible, speeds recovery.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can help manage the pain. As the pain subsides, begin gradually doing the exercises.

For a person with severe muscle strain, there is a risk of the muscle tearing away from the tendon, with surgery being the only treatment. After surgery, a person usually needs to wear a sling for several weeks. Often, doctors also recommend physical therapy (PT). Most people recover completely.

Muscle damage

Muscle damage is another possible cause of biceps pain. This occurs when blunt force compresses the small blood vessels inside the muscle. Blood leaves the damaged vessels and enters the muscle. Sports injuries, falls and other accidents can cause a biceps bruise. A bruised muscle may be painful to the touch.

Treatment methods

The best approach is to follow muscle strain treatment methods. Healing of a bruise can take from 2 weeks to several months.

Delayed onset muscle soreness syndrome

Delayed onset muscle soreness occurs when muscles become overworked, usually during exercise. This happens when you start a new activity or increase the intensity of your workout. Long-term muscle soreness can affect any muscle in the body, including the biceps. Symptoms include pain and tenderness in the biceps. It hurts a person to straighten his arm or carry things. The pain usually begins 6-8 hours after exercise and can last up to 48 hours.

For treatment, NSAIDs may be used to help manage symptoms. Massage and rest can also relieve pain and soreness.

Heart attack

Sometimes pain in the left arm can signal a heart attack. This occurs when part of the heart does not receive the blood it needs to function properly. The pain usually comes on suddenly and may radiate from the shoulder down into the biceps area. Other symptoms of a heart attack include:

pain or discomfort in the left or central part of the chest
feeling weak or dizzy
cold sweat
pain or discomfort in the jaw, neck, or back
dyspnea
unexplained fatigue
nausea and vomiting

Chest pain or discomfort may last a few minutes or may pass and return. People have described it as a feeling of pressure, tightness, or fullness in the chest. The sooner a person receives medical help, the greater the likelihood of recovery.

Diagnostics

The doctor may be interested in the history of the disease (presence of injuries or characteristics of activity). A physical examination is often most helpful in diagnosing biceps tendonitis. The examination allows you to detect the presence of painful movements or muscle weakness, changes in the amplitude of movements. In addition, there are specific functional tests that suggest the presence of rotator cuff injuries or the presence of shoulder instability.

Radiography allows you to diagnose the presence of osteophytes in the tendon. X-rays do not visualize the tendons and, if treatment is not effective, an MRI examination is prescribed. MRI can detect changes not only in the tendons, but also the presence of damage to the rotator cuff or labrum.

Diagnostic arthroscopy is an invasive diagnostic method and is used not so much to diagnose biceps tendinitis, but to diagnose other shoulder problems that could not be diagnosed using X-rays or MRI. Using arthroscopy, the surgeon can visually assess the condition of the rotator cuff, labrum, or part of the biceps tendon located inside the joint.

Prevention

Muscle injuries often occur when people suddenly increase the duration, intensity, or frequency of exercise.

Doctors advise:

Start or add new activities slowly and gradually increase their intensity.
Always warm up before working out or other strenuous activities.
Drink plenty of water during exercise.
Take regular rest days to allow your muscles to recover.

A healthy lifestyle is the best way to prevent a heart attack. To do this you need:

balanced diet
maintaining a moderate weight
regular exercise
to give up smoking

Treatment

Conservative treatment

Conservative treatment is most often used for biceps tendinitis. Treatment, first of all, consists of unloading the biceps tendon (rest and avoiding stress on the tendon). Drug treatment includes taking NSAIDs, which can relieve pain and reduce inflammation.

Physiotherapy can reduce the inflammatory process. Exercise therapy is necessary to restore muscle strength. In addition, if there are activities that contribute to rotator cuff injury or instability, modification of the patient's activities is necessary. As a rule, such measures can reduce pain and inflammation and return to normal daily activities. Steroid injections are sometimes possible, but since they can further weaken the tendon, their use is quite limited.

Surgery

Surgical treatment is indicated only for those patients who have failed conservative treatment or have other problems in the shoulder.

Acromioplasty is the most common surgery for biceps tendonitis, especially if there is shoulder impingement. This surgery involves removing the front of the acromion, thereby increasing the space between the acromion and the head of the humerus. Thanks to the increase in space, pressure on the tissues, including the biceps tendon, disappears. Typically, acromioplasty is performed using arthroscopy. In some cases, the surgeon also reattaches the deltoid muscle to the acromion.

If the biceps tendon is severely damaged by degeneration, the surgeon may perform biceps tenodesis.

Biceps tenodesis. This surgery is to reattach the upper end of the biceps tendon to a new location. Studies show that the long-term results of this operation are not very good but, nevertheless, tenodesis is necessary for severe degeneration of the biceps tendon. Tenodesis is also most often performed using arthroscopic techniques.

Rehabilitation after surgery

Some surgeons recommend starting to move gently soon after surgery. Exercises must be performed gradually and carefully, as regeneration progresses, under the supervision of a physical therapy specialist. 2-4 weeks after surgery, you can begin actively strengthening the muscles of the shoulder and forearm. In addition to exercise therapy, it is possible to use physiotherapy, which can speed up regenerative processes. Typically, rehabilitation after surgery can take 6 to 8 weeks. Full restoration of functions usually requires 3-4 months.

About the causes of biceps tendonitis

It takes quite a long time for the biceps tendon tissue to regenerate. If a person, while performing his professional duties or playing sports (in particular, tennis, basketball, swimming), acts very intensely and at the same time performs monotonous movements with his arms above his head countless times, the tendon constantly bears excessive load, and full regeneration in it is simply not possible. manages to happen.

If the biceps tendon wears out, its tissue begins to degenerate, and the condition of the collagen fibers that form the tendon is disrupted - they can become tangled and even tear. Obviously, degeneration robs the tendon of strength and leads to inflammation, and can also cause it to rupture.

Injury to the shoulder from a fall and a strong blow to the upper part of the shoulder is very likely. In this case, the transverse humeral ligament, which holds the biceps tendon in a special (so-called bicipital) notch near the top of the humerus, may rupture. A rupture of this ligament causes the biceps tendon to unhinderedly jump out of the bicipital notch, cause irritation and the onset of an inflammatory process.

While we're talking about the causes of biceps tendinitis, it's also important to explain problems such as shoulder instability, shoulder impingement, and rotator cuff tears.

Experts talk about the possible occurrence of shoulder instability if the head of the humerus is constantly forced to make repeated movements in the shoulder socket (for example: an athlete sharply throws or hits a ball, intensively waves his arms while swimming). So, the prerequisite for manifestations of shoulder instability should be long-term excessive loads on soft tissues, which provide the head of the humerus with a stable position in the socket.

When the shoulder is dislocated, the so-called labrum (upper lip) can be torn where it attaches to the joint, and then nothing can stop the head of the humerus from moving in the socket, even if this movement is not necessary. As a result of such uncontrolled movement of the humerus, nearby tendons can be damaged, and then signs of biceps tendinitis may appear.

Shoulder impingement can occur when arm movements impinge on the soft tissue located between the acromion (which is just the top of the shoulder blade) and the head of the humerus.

Rotator cuff tears most often occur due to age-related changes in the body. And in this case, the head of the humerus moves freely in the shoulder socket, regardless of the will of the person, which has a detrimental effect on the condition of the biceps tendon, weakening it and inevitably causing inflammation.

About the symptoms of biceps tendinitis and its diagnosis

A dull pain most often appears in the upper or anterior part of the shoulder, but sometimes it spreads lower, involving the area where the biceps muscle is located. The pain may increase with raising the arm and decrease with rest. Bending the elbow and turning the forearm cause a feeling of weakness. If a patient complains of a feeling of blocking or sliding, the doctor may suspect that the transverse shoulder ligament has been torn.

The doctor will definitely ask the patient about the nature of his work, the intensity of sports (if any), about possible injuries, and during the examination he will pay attention to the peculiarities of performing movements, their possible difficulty due to muscle weakness or pain. And the results of special tests may indicate a problem such as shoulder instability or rotator cuff damage.

It is not always possible to choose the right treatment solely on the basis of x-ray results. Therefore, the patient should be prepared to undergo an MRI, which will give the doctor a basis to judge the presence (absence) of an inflammatory change in the tendon, labrum damage, or rotator cuff tears.

To identify or, conversely, exclude the presence of other shoulder problems in the patient, the surgeon may also prescribe diagnostic arthroscopy. This examination method gives the specialist the opportunity to see with his own eyes the lambrum, rotator cuff and even the intra-articular part of the biceps tendon and assess their condition.

About conservative and surgical methods of treating biceps tendinitis

Biceps tendinitis is mainly treated with a conservative method, which is characterized by the following prescriptions:

- take non-steroidal anti-inflammatory drugs (NSAIDs), which will reduce pain and relieve inflammation (injections of steroid drugs are prescribed very limitedly due to the fact that they weaken the tendon to an even greater extent);

- eliminate stress on the tendon and ensure its rest;

- undergo physical therapy (to reduce the inflammatory process) and exercise therapy (to restore muscle strength).

Sometimes the doctor will recommend that the patient change his or her activity if the current activity poses a risk of shoulder instability or rotator cuff tear. In this way, pain and inflammation can be significantly reduced, which will allow a person to live a full life.

Surgical treatment of biceps tendinitis is prescribed if there is no effect from conservative treatment or if some other problems are identified in the patient’s shoulder.

For biceps tendinitis (especially in the presence of shoulder impingement), acromioplasty is most often performed. During the operation, performed using arthroscopy, the anterior part of the acromion is removed, thereby increasing the distance between it and the head of the humerus. In this way, pressure on the tendon and other tissues is reduced. Sometimes it is necessary to reattach the deltoid muscle to the acromion.

If there is severe degenerative damage to the tendon, biceps tenodesis is indicated. In this procedure, often using arthroscopy, the upper end of the biceps tendon is reattached to a new location. Unfortunately, the results of biceps tenodesis are not very durable, but if the tendon is severely damaged, this method of surgical treatment remains relevant.

About rehabilitation in the postoperative period

Typically, rehabilitation after surgical treatment of biceps tendinitis takes 6–8 weeks. Much depends on the positive attitude of the patient himself, his attitude towards life.

Patients are not recommended to “lie back” after surgery; it is better to begin to carefully perform movements soon after it. A physical therapy specialist will monitor the patient’s efforts aimed at strengthening the muscles in the shoulder and forearm. Already after 2 to 4 weeks after surgery, these efforts can and should become very active.

To accelerate regenerative processes in the tendon and other tissues, physiotherapy is prescribed.

If you follow all the recommendations of doctors and persistently perform the exercises, it will take 3 to 4 months to fully restore the functions of the shoulder and forearm.

Localization

The triceps muscle occupies more than half of the entire shoulder joint. Many sports equipment and exercises are aimed specifically at its development to make the arms more massive. The triceps is attached to the ulna bone by the triceps tendon.

With repeated contraction of the triceps muscles, as with pull-ups or push-ups, the main load falls on the tendons, then all the conditions may arise for the occurrence of such an unpleasant disease as triceps tendonitis, which occurs due to wear and tear of the triceps tendon. Older athletes are at risk, since mineral metabolism slows down with age.

Main risk factors:

muscle weakness
incorrect load distribution during training
old back or neck injuries
elbow stiffness
infections
impaired metabolism

Symptoms:

The disease is accompanied by pain in the back of the elbow, which is aggravated by repetitive stress associated with constant bending of the elbows (pull-ups, bench press, or even regular hand washing). In advanced cases, swelling of the back of the elbow may occur as a result of inflammation. The pain can become acute when the triceps muscles are tense or the elbow comes into contact with a hard surface. A feeling of weakness may occur when straightening the affected joint.

How can you tell if you have triceps tendinitis?

First of all, you should not engage in self-diagnosis and self-medication. Only a doctor can correctly determine triceps tendonitis after examination or laboratory tests. The doctor pays attention to the appearance of the arm in the tendon area (possible swelling and redness). If necessary, radiography may be prescribed to exclude possible damage to bone tissue. They may also prescribe an MRI, the procedure of which will help the doctor examine not only the condition of the bone, but also the triceps tendon itself and determine the extent of its damage, if any, of course.

Prevention

Preventing a disease is always easier and more logical than treating it later. The following measures can be taken to prevent triceps tendinitis:

Do a pre-warm-up before each physical activity or workout.
Increase the load on the triceps gradually. Try to avoid sudden loads.
If any discomfort occurs, and especially pain in the back of the elbow during a load localized in the triceps tendon area, immediately reduce the load or take a break. No need for fanaticism.
Refrain, if possible, from prolonged work involving monotonous movements of the same joint.

Treatment

First of all, you should immediately stop activities that cause pain and involve constant stress on the triceps tendon. If you do not provide complete rest to the damaged tendon, then any most effective treatment method turns out to be meaningless. There are several effective treatments for triceps tendinitis:

What we can do ourselves is to apply a fixator for maximum immobilization (elastic bandage, splint, etc.), and frequently apply cold to the damaged joint.
The use of physiotherapy such as: magnetic laser, shock wave. Often this treatment method brings the greatest results. Prescribed independently or in combination with basic drug treatment.
Drug treatment is prescribed only by a doctor when the inflammatory process develops. Anti-inflammatory drugs such as diclofenac and ibuprofen are usually used. In more severe cases of inflammation, antibiotics may be prescribed.
Treatment with traditional methods

Surgical intervention is urgently used when a tendon ruptures. It is important to have surgery within two weeks of the rupture. The postoperative rehabilitation period is at least two months, complete recovery is at least three to four months from the date of the operation.

Good health to you!
Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr