Biceps tendinitis is an inflammation of the upper end of the long head of the biceps tendon. The biceps muscle in front of the arm has two tendinous origins in the shoulder: the long head from the glenoid (socket part of shoulder joint) and the short head from the coracoid bone (bone present in front of the shoulder blade).
Biceps tendinitis is commonly caused by overuse of the shoulder, which could be due to sports like swimming, baseball or tennis, or any activity that requires repetitive overhead motion. Biceps tendinitis is commonly associated with other conditions like tears of the glenoid labrum, shoulder instability, shoulder impingement, shoulder arthritis or other inflammatory conditions of the shoulder joint.
When tendinitis happens, the tendon becomes inflamed and swollen in early stages, but in later stages it can get partially or completely torn. The complete tear is followed by a ‘Popeye’ type of bulge in the upper arm.
Usual symptoms are pain and achiness in the front of the shoulder, which moves down the upper arm. There could be other symptoms based on associated findings of a labral tear, instability, impingement or arthritis. The diagnosis can be made by a detailed exam, but radiological imaging including X-rays and MRI are performed if a concomitant labral tear or other pathologies are suspected.
Treatment depends on a concomitant major pathology like a labral tear. In an isolated biceps tendinitis case, it is first treated with anti-inflammatory medications, rest, ice and physical therapy. Steroid injection in the biceps tendon sheath can be done cautiously, but it carries a risk of rupture of tendon. If the condition doesn’t improve after conservative treatment, surgery is recommended. Surgery could be also recommended earlier if you have associated other problems like a labral tear, which needs to be addressed earlier than later. Surgery for biceps tendinitis in young patients who have failed conservative treatment is biceps tenodesis, in which a damaged part of tendon is excised and the normal remaining part of tendon is attached to the arm bone. In older patients, the other option is biceps tenotomy in which tendon is just cut and released from its attachment on the glenoid (shoulder blade). Physical therapy is required after the operation.
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