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Biceps Tendonitis

Biceps Tendonitis web based movie

Overview

The biceps muscle is located in the front of the arm and is active in motion of both the shoulder and the elbow. The muscle has two heads (“bi-“) that originate separately from different locations on the front of the shoulder. The long head of the biceps originates as a tendon attached to the top of the socket of the shoulder joint. From here the tendon passes through the shoulder joint, over the upper end of the arm, and through a groove in the arm bone at the front of the shoulder, which is known as the bicipital groove.

Biceps tendonitis is inflammation of the long head of the biceps tendon either within the shoulder joint or the bicipital groove. Inflammation may result from repetitive, heavy shoulder activity such as weightlifting or with wear-and-tear over time. As the shoulder moves or the biceps muscle is flexed, the inflamed biceps tendon rubs within the joint or the groove and causes pain.

Symptoms

Symptoms of biceps tendonitis typically involve gradually worsening pain in the front of the shoulder that may radiate down the front of the arm. Pain may be quite sharp at times, and is often worse with certain movements, such as lifting objects with the arm extended in front of the body, reaching behind the back, or bending the elbow against resistance (i.e. – biceps curls). Biceps tendonitis may frequently be associated with other shoulder conditions, including rotator cuff tears and impingement syndrome. Symptoms from these associated conditions may cloud the pain from biceps tendonitis and make the diagnosis somewhat challenging at times.

Diagnosis

The diagnosis of biceps tendonitis is usually made by a combination of history of the patient’s symptoms and findings during physical examination. X-rays are usually obtained to rule out other sources of shoulder pain, but are usually normal in cases of isolated biceps tendonitis. A MRI scan is helpful to evaluate tearing or degenerative changes in the biceps, instability of the biceps in the groove, and associated shoulder issues.

Treatment

Initial treatment of biceps tendonitis is usually non-operative and involves rest and activity modification, icing, anti-inflammatories, physical therapy, and possibly a cortisone injection. Cortisone injections are helpful at alleviating pain but may contribute to biceps tendon rupture if it is severely degenerated at the time of injection. If non-operative treatment fails to provide lasting pain relief, surgery is generally recommended.

During surgery the biceps tendon is evaluated directly for evidence of degeneration and fraying. Surgical treatment options include:

  • Biceps debridement: removing only the torn portion of the biceps and leaving the remaining healthy portion of the tendon intact
  • Biceps tenotomy: cutting and releasing the biceps from its attachment site at the top of the shoulder socket so it no longer rubs inside the joint or bicipital groove
  • Biceps tenodesis: cutting the tendon from the top of the shoulder and re-attaching it to the front of the shoulder to stabilize the tendon origin outside the shoulder joint to prevent rubbing and irritation.

These procedures are done arthroscopically and in a minimally invasive manner.

Additional Information

For more information, visit http://orthoinfo.aaos.org/topic.cfm?topic=A00026.

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