Bicep Tendonitis : Treatment and Exercises Strategies
Biceps
tendonitis, also known as bicipital tendonitis, is a condition characterized by
inflammation or irritation of the biceps tendon. The biceps tendon attaches the
biceps muscle to the shoulder and the elbow. Tendonitis often occurs due to
overuse, repetitive movements, or sudden injury usually in athletes older than
35years or non-athletes older than 65years.
Predisposing Factors:
- Impingement syndrome - act source of mechanical impingement
- Osteoarthritis - due to formation of bone spur
- Glenoid labrum Tear
- Shoulder dislocation
Classification of Bicep Tendonitis
Proximal Biceps Tendonitis:
This type affects the upper part of the biceps tendon, where
it attaches to the shoulder joint. Proximal biceps tendonitis is common among
athletes who engage in overhead activities, such as baseball pitchers or tennis
players.
Distal Biceps Tendonitis:
Distal biceps tendonitis occurs at the lower end of the
biceps tendon near the elbow joint. It often results from repetitive lifting or
forceful pulling motions, such as weightlifting or manual labor.
Partial Biceps Tendon Tear:
In some cases, severe tendonitis may lead to partial
tearing of the biceps tendon. This can cause significant pain, weakness, and
instability in the affected shoulder or elbow.
Complete Biceps Tendon Tear:
A complete tear of the biceps tendon can occur, usually as
a result of sudden trauma or long-term degeneration. This type of injury often
requires surgical intervention to repair the tendon and restore function.
Causes of Bicep Tendonitis
- Overuse injury
- Poor posture
- Muscle weakness or imbalance in the muscles surrounding the shoulder joint
- Degenerative changes in the tendon can also increase the risk of tendonitis
- Direct trauma or injury to the shoulder or elbow - such as a fall
- Sports or physical activities - such as baseball, tennis, swimming, or weightlifting
- Previous shoulder injuries
- Rheumatoid Arthritis
- Gout
- Bone spurs
- Shoulder Impingement
Bicep Tendonitis Symptoms
- Pain can be dull, aching, or sharp usually felt at anterior aspect of shoulder
- Pain is localized around bicipital groove or travel down the radial nerve distribution
- Pain worsen with certain movements - such as lifting, overhead activity or reaching behind the back
- Pain usually worsen during night
- Tenderness
- Swelling
- Weakness may be noticeable during gripping
- Stiffness or restricted range of motion in the shoulder or elbow joint
- Popping or clicking sensation
Diagnosing Bicep Tendonitis
History
Medical
History: Begin by taking a thorough medical history, including information
about the onset and duration of symptoms, any recent trauma or overuse
activities, previous shoulder injuries or surgeries, and any relevant medical
conditions.
Symptom
Assessment: Evaluate the patient's symptoms, including pain, tenderness,
swelling, weakness, and restricted range of motion in the shoulder and upper
arm. Determine the location and severity of the pain and any factors that
exacerbate or alleviate the symptoms.
Physical Examination
Perform a detailed physical examination of the shoulder and upper
arm. This may include:
Palpation: Palpate the biceps tendon along its course, including its attachment points at the shoulder and elbow, to assess for tenderness along bicipital groove, swelling, or nodules.
Range of
Motion: Assess active and passive range of motion in the shoulder and elbow
joints, looking for any limitations or pain with specific movements, such as
flexion, extension, abduction, adduction, internal rotation, and external
rotation. One of the common finding is 10 degree of internal rotation when the patient hold his arm normally.
Strength Testing
Evaluate the strength of the biceps muscle and other shoulder muscles
using manual muscle testing or functional tests, such as resisted flexion and
abduction.
Bicep Tendonitis Test (Special Tests)
They are perform to assess for biceps tendon pathology, labral tears,
or other shoulder disorders.
- The Yergason Test - it is considered positive if pain is referred to the bicipital groove.
- The Neer test - if the patient experiences pain, it is a positive sign of impingement syndrome.
- Hawkins test - it is positive if bicipital groove pain is present. For the
- Speed test - pain reproduces in bicipital tendon or groove
Functional Assessment
Assess the patient's functional limitations and activity level,
including any difficulties with activities of daily living, work-related tasks,
or sports activities.
Diagnostic Imaging
While not always necessary for diagnosing biceps tendonitis,
diagnostic imaging studies such as X-rays, ultrasound, or MRI may be ordered to
confirm the diagnosis, rule out other shoulder pathologies, and assess the
severity of tendon involvement.
- CT - shows biceps tendon subluxations, ruptures, dislocations, and SLAP lesions
- Radiography - shows the width and medial wall angle of the bicipital groove, spurs formation in the groove
- MRI - for evaluation of the superior labral complex and biceps tendon
Differential Diagnosis
- Rotator Cuff Tendonitis
- Shoulder Impingement Syndrome
- Glenohumeral Joint Arthritis
- Labral Tear
- Frozen Shoulder (Adhesive Capsulitis)
- Cervical Radiculopathy
- Biceps Tendon Rupture
- Shoulder Instability
- Referred Pain
- Brachial Plexus Injury
Treatment of
Treatments
for bicipital tendonitis include a multimodal approach, as listed below:
Electrotherapeutic Modalities
- Laser Therapy
- Cryotherapy
- Therapeutic Ultrasound
- Extracorporeal Shock Wave Therapy (ESWT)
Bicep Tendonitis Exercises
Exercises
for biceps tendonitis typically focus on strengthening the muscles around the
shoulder and elbow, improving flexibility, and correcting any biomechanical
issues contributing to the condition. Here are some common exercises that may
be beneficial for biceps tendonitis:
- Shoulder Blade Squeezes
- Rotator Cuff Strengthening Exercises
- Biceps Stretch
- Triceps Stretch
- Doorway Stretch
- Prone YTWLs
- Wall Angels
- Isometric Biceps Contraction
Soft Tissue Mobilization
Soft tissue
mobilization techniques can help reduce muscle tension, improve blood flow, and
promote healing in cases of biceps tendonitis. Here's a basic guide on how to
perform soft tissue mobilization for biceps tendonitis:
Kinesio-Tape for Bicep Tendonitis
Kinesio taping is used
for biceps tendonitis as it provide skin lifting effect by creating interstitial
space in stretched tissue, it also promote lymphatic and venous flow along with
increased tissue regeneration. KT tape helps in pain reduction by creating
decompression in subcutaneous nociceptors in connective tissue.
Frequently Asked Questions
What is bicep tendonitis recovery time?
The recovery
time for biceps tendonitis can vary depending on several factors, including the
severity of the injury, the individual's overall health, the effectiveness of
treatment, and adherence to rehabilitation protocols.
- Acute Phase (1-2 weeks): During this phase, the focus is on reducing pain and inflammation.
- Subacute Phase (2-6 weeks): As pain and inflammation subside, emphasis shifts to gentle stretching and strengthening exercises.
- Rehabilitation Phase (6 weeks to several months): In this phase, progressive strengthening exercises and functional activities are introduced to restore full range of motion and strength to the affected arm.
How to sleep with bicep tendonitis?
Sleeping
with biceps tendonitis can be challenging due to the discomfort and pain
associated with the condition, especially when lying on the affected side. Here
are some tips to help you sleep more comfortably with biceps tendonitis:
- Try to avoid sleeping on the side of the affected arm
- Use extra pillows to support your arm and keep it in a comfortable position e.g. wedge pillow
- Apply an ice pack to the affected area for 15-20 minutes to help reduce swelling
- Take over-the-counter pain medication - such as ibuprofen or acetaminophen
- Engage in relaxation techniques such as deep breathing, progressive muscle relaxation
- Wear comfortable clothing as it can aggravate pain and discomfort
- Wearing a night splint or brace is also considered to keep the arm in a neutral
Which exercises are avoided with bicep tendonitis?
When dealing
with biceps tendonitis, it's important to avoid exercises that may exacerbate
symptoms or put undue stress on the affected tendon.
- Heavy Biceps Curls - barbell curls, dumbbell curls, and preacher curls.
- Overhead Pressing Movements - such as shoulder presses or military presses
- Pull-Ups and Chin-Ups
- Push-Ups
- Dips
- Aggressive Stretching
Which sports increase the risk of bicep tendonitis?
- Swimming
- Baseball or softball
- Tennis
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