Inflammation of 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 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 latent case of biceps tendinopathy known as biceps rupture.
The biceps tendon may at times get inflamed at its insertion site near elbow, which is again referred as biceps tendonitis.
Biceps originates through two heads, the long head from the supraglenoid tubercle, it runs superiorly to enclose the head of humerus and then it runs down through the bicipital groove. The tendon is intrarticular but extrasynovial with the help of a suspensory ligament that encloses the tendon during its intrarticular 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 radius bone. It gives off an aponeurosis that blends with the fascia on the medial aspect of forearm.
Biceps tendinopathy results from several underlying pathologies and is rarely seen in isolation. It occurs as a result of overuse of injured or impinged tendon, shoulder instability and abnormal shoulder alignment because of 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.
The common symptoms are-
- Pain may be localized in the anterior shoulder region or may be radiating down to the elbow.
- Overhead activity reproduces the pain, especially movements like lifting the arm though the sides and taking the hand at the back of 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 patient’s history, signs and symptoms and clinical examination. Though there may be other underlying pathologies which need thorough evaluation of shoulder joint.
An MRI may be needed at times to confirm the diagnosis.
The physiotherapy treatment aims at-
Pain and inflammation control and Protection
Activity modification: Patients are advices 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 ergonomical 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 shoulder blade and shoulder joint. So these areas also need to be addressed to correct shoulder issue. 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 meets the specifically 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.