What is Biceps Tendonitis
Inflammation of the Bicep tendon is known as Biceps Tendonitis. This condition mainly occurs due to friction in the bicipital groove (groove present on the anterior aspect of the humerus between greater and lesser tubercle) so this condition is also known as bicipital tendonitis.
The tendon may tear off at times secondary to degenerative changes in the latent case of biceps tendinopathy known as Biceps Rupture.
The biceps tendon may at times get inflamed at its insertion site near the elbow, which is again referred to as biceps tendonitis.
Anatomy Of Biceps
Biceps originate through two heads, the long head from the supraglenoid tubercle, it runs superiorly to enclose the head of the humerus, and then it runs down through the bicipital groove. The tendon is intraarticular but extra synovial with the help of a suspensory ligament that encloses the tendon during its intraarticular course. This particular head is more susceptible to friction injury in the bicipital groove.
The other (short) head originates from the coracoids process. The two heads unite to form the biceps belly. The muscle inserts at the radial tuberosity present on the medial side just below the neck of the radius bone. It gives off an aponeurosis that blends with the fascia on the medial aspect of the forearm.
Biceps tendinopathy results from several underlying pathologies and is rarely seen in isolation. It occurs as a result of the overuse of the injured or impinged tendon, shoulder instability, and abnormal shoulder alignment because of the wrong posture. Therefore, it coexists with pathologies like rotator cuff impingement syndrome, rotator cuff tears, Labral tears, SLAP lesions, and or shoulder instability.
This condition is common in sports that involve excessive shoulder use like swimmers, gymnasts, and other contact sports. Occupations that require frequent overhead shoulder activity or heavy lifting are at risk.
Symptoms of Biceps Tendonitis
The common symptoms are-
- Pain may be localized in the anterior shoulder region or maybe radiating down to the elbow.
- Overhead activity reproduces the pain, especially movements like lifting the arm through the sides and taking the hand at the back of the head e.g. throwing action.
- Patients may describe muscle weakness, clicking, or snapping with shoulder movements.
The condition can be easily diagnosed by an expert physiotherapist on the basis of the patient’s history, signs, and symptoms, and clinical examination. Though there may be other underlying pathologies that need a thorough evaluation of the shoulder joint.
An MRI may be needed at times to confirm the diagnosis.
Treatment of Biceps Tendonitis
The Physiotherapy Treatment aims at-
- Pain and inflammation control and Protection
Activity modification: Patients are advised to avoid painful activities and avoid sleeping on the affected side with the help of a pillow.
Tapping: Tapping can be done to unload the painful structure and ease movement.
Ice: Icing is an effective way to reduce pain and swelling. Apply ice for 10-15 mins every 2-3 hours.
Other physiotherapy modalities and techniques can be used to control pain and inflammation.
- Patient Education & Technique Correction
The physiotherapist will assess and discuss postures that a patient mostly stays in throughout the day and give proper ergonomic advice for postural correction.
- Improve joint range of motion & flexibility
Once pain reduces considerably, the physiotherapist will assess muscle and joint flexibility and work on the deficits present.
- Improve Joint Stability & Strength
As most of the time, joint instability is a major cause of bicipital tendinopathy, the physiotherapist needs to design a customized exercise protocol to address the instability issue.
- Improve Neck & Thoracic Posture & Mobility
At times the neck and upper back posture and hypomobility can be the contributing factors for the abnormal positioning and movement pattern of the shoulder blade and shoulder joint. So these areas also need to be addressed to correct shoulder issues. An experienced physiotherapist will be able to diagnose the problem correctly and treat them effectively.
- Restore Normal Function: Speed, Load, Power & Proprioception
The treatment will vary depending on the functional requirements that meet the specific need of one’s shoulder.
The condition can be successfully rehabilitated with a well-guided exercise regime. The inflammatory versions i.e. tendonitis and tenosynovitis will respond quicker than the degenerative form i.e. tendinosis, where cell death within the tendon has set in. It is important to rehabilitate these tendon injuries since they are the most likely to rupture in the future. Concurrent injuries may also be present with biceps tendinopathy like rotator cuff tendonitis which needs to be addressed as well.