What is Biceps Tendinitis (Tendonitis/Tendinopathy)?
Biceps tendinitis / tendonitis / tendinopathy describes pain and
tenderness in the region of the biceps tendon. The biceps
musculotendinous junction is particularly susceptible to overuse
injuries, especially in individuals performing repetitive lifting
activities. This condition is often diagnosed incorrectly and confused
with rotator cuff disease.
Biceps tendinopathy is rarely seen in
isolation. It coexists with other pathologies of the shoulder,
including rotator cuff tendinopathy and tears, shoulder instability,
and imbalances of the rotator cuff.
Historically, all disorders of the biceps tendon have been termed
biceps tendinitis. Recent evidence suggests that degenerative changes
in the tendon occur without inflammation. In acute cases, an
inflammatory pathology may still be a valid explanation of biceps
tendon pain.
Tendinitis describes inflammation of the tendon and the paratendon.
This is usually caused by chronic overload, leading to microscopic
tears in the tendon, which triggers an inflammatory response.
Peritendinitis is the inflammation of the paratendon or tendon sheath.
This usually occurs as a result of a direct injury or irritation in
which the tendon rubs over a bony prominence; this is referred to as a
tenosynovitis.
Tendinosis is degenerative changes in the tendon.
Anatomy of the Biceps Tendon
The anatomy of the biceps brachii muscle is important in
understanding biceps tendinopathy. The biceps brachii has 2 heads.
The
short head arises from the tip of the coracoid process of the scapula.
The long head arises from the supraglenoid tubercle of the scapula and
the superior labrum runs through the intertubercular groove between the
greater and lesser tubercles of the humerus.
Proximally, the long head
of the biceps acts as a shoulder stabilizer through depression of the
humeral head (Kumar, 1989). The 2 heads join together in the distal arm
to form one strong tendon, which inserts on the radial tuberosity on
the upper end of the radius. Distally, the tendon gives off the
bicipital aponeurosis (an expansion that blends with the flexor forearm
muscles, extending to the ulna).
The biceps brachii is innervated by
the musculocutaneous nerve (C5, C6).
The actions of the biceps brachii muscle is flexion of the elbow,
supination of the forearm, humeral head depression, and shoulder
flexion (short head primarily).
History of Bicipital Tendinitis
Diagnosis is primarily clinical. Patient history suggests the diagnosis.
Pain is reported in the region of the anterior shoulder
located over the bicipital groove, occasionally radiating down to the
elbow.
- The pain is aggravated by activities that require shoulder flexion, forearm supination, and/or elbow flexion.
- Pain is usually exacerbated by initiating activity.
- Some describe fatigue with shoulder movements.
- The symptoms are alleviated by rest, ice, massage, stretching, and, sometimes, heat.
- Night pain is not uncommon.
Physical
Causes of Bicipital Tendinitis
- Poor lifting techniques
- Chronic repetitive upper extremity activities (shoulder/elbow flexion)
- Impingement syndrome
- Rotator cuff pathology
- Biceps subluxation
- Shoulder girdle muscle imbalances
- Poor posture
- Overload (usually eccentrically)
- Lack of flexibility/capsular tightness
- Direct trauma
- Multidirectional shoulder instability
- Calcifications of the tendon
- Osteoarthritis and spurring
- Anatomical abnormalities (eg, variations of the bicipital groove, fractures, first rib subluxations)
Common Treatments for Bicipital Tendinitis
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