Biceps Tendinitis

Biceps tendinitis is inflammation of the tendon around the long head of the biceps muscle in the bicipital groove. This is known as primary biceps tendinitis and occurs in 5% of patients with biceps tendinitis (3). Biceps tendinitis and tendinosis are commonly accompanied by rotator cuff muscle tears or SLAP (superior labrum anterior to posterior) lesions (3). Patients often complain of a deep, throbbing ache in the anterior shoulder and repetitive overhead motions of the arm initiate or exacerbate the symptoms. The most common isolated clinical findings in biceps tendinitis is bicipital groove point tenderness whilst the arm is moved to 10 degrees of internal rotation (Figure 1). Pathology of the biceps tendon is most often found in patients 18 to 35 years of age who are involved in sports (3).

Stages

In the early stages of biceps tendonitis, the tendon often becomes inflamed and swollen, the tendon sheath can thicken or grow larger as the tendinitis develops and the tendon becomes dark red in color in the late stages due to inflammation (3).

Occasionally, a partial or complete tear of the tendon may occur from injury or damage. Biceps tendinitis and tendinosis are commonly accompanied by rotator cuff tears or SLAP (superior labrum anterior to posterior) lesions. A complete tendon tear can result to a deformity of the arm (3).

Biceps tendinitis commonly occurs along with other shoulder problems. Other problems that often accompany biceps tendinitis include:

• Arthritis of the shoulder joint
• Rotator cuff tears
• Tears in the glenoid labrum
• Shoulder instability
• Other diseases that cause inflammation of the shoulder joint lining.

As we age, most of our daily routine activities can cause wear and tear within the biceps tendon which may result to weakness overtime. Repeating the same shoulder movements over again throughout the day along with poor shoulder and upper back posture can be the cause for wear and tear. Biceps tendinitis can occur from sudden, serious load or strain to the tendon such as lifting a heavy item or performing DIY.

Primary impingement syndrome is considered the most common cause of biceps tendinosis or tenosynovitis (i.e., inflammation of the tendon sheath). This is a mechanical impingement under the coracoacromial arch caused by bone spur formation of the acromion or can occur from thickening of the coracoacromial ligament (3). It may also be caused by osteoarthritic spurs impinging on the bicipital groove (3).

Various jobs and activities can lead to overuse and damage to the biceps tendon. Repetitive overhead motion during certain sports such as swimming, tennis, and baseball can also put people at risk for biceps tendinitis. 

The main function of the biceps muscle is supination (turning the palm of the hand to face the ceiling) and elbow flexion. The muscle contributes approximately 10% of the total power in shoulder abduction when the arm is held in external rotation.
The function of the LHB tendon tends to play a passive stabilising role in the shoulder and it has been proposed that the stabilisation of the LHBT is dependent on the elbow's positioning (9).

An osteopathic treatment might involve the practitioner assessing positioning and posture of the neck, shoulders and back along with performing clinical tests to understand which specific muscles or joint related compensations might be contributing to maintaining biceps tendonitis.

Your osteopath does not prescribe medications, but biceps tendinitis or tendinosis may respond to analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs), ice, rest from overhead activity (if perform related activities), or physical therapy.

Shoulder stability and posture related exercises might be prescribed along with specific muscle stretches. The goal of stretching is to regain a balanced range of motion without stiffness or pain in any position. Interestingly, Churgay (2009) believes that a stretching program should include stretching and exercising the hamstrings and lower back as well. A subtle loss of motion in the lower back and hamstrings may lead to a major imbalance of the shoulder-stabilising ligaments and the scapula (Churgay, 2009).

Corticosteroid Injection

If additional therapy is needed for pain relief, or if the diagnosis is in doubt, an injection of local anesthetic (e.g., 1% lidocaine with or without a mild corticosteroid solution) into the biceps tendon sheath and a referral might be suggested and considered.

Surgery

Surgery is only considered if conservative measures fail after than three months. Structures causing primary and secondary impingement may be removed, and the biceps tendon repaired if necessary. Debridement or arthroscopic shaving of torn fibers might be performed if less than 50% of the biceps tendon is torn (3). Biceps tenodesis may be considered in serious tears or rupture which involves the attachment of the torn biceps tendon to the bicipital groove or transverse humeral ligament with suture anchors or screws (3). A biceps tenotomy is also a possibility whereby the ruptured biceps tendon is removed from the glenohumeral joint, and tenodesis might be avoided without significant loss of arm function. Tenotomy is the procedure of choice for inactive patients 60 years and older with a ruptured biceps tendon. Tenodesis is a reasonable option for patients younger than 60 years, as well as active patients, athletes, manual laborers, and patients who object to a muscle bulge above the elbow.

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