Biceps Tendonopathy

​Bicep tendinitis / tendonitis / tendinosis / tenosynovitis are all terms that describes pain or injury to one of your shoulder's bicep tendons.

Tendinopathy is the general term for tendon impairments and encompasses the variety of pathological processes that are found in tendon injuries.  Tendinitis/tendonitis is probably the most commonly referred term, but tendinopathy of the biceps tendon can be distinguished as:

• ​biceps tendinitis/tendonitis (inflammed tendon).
• biceps tendinosis (non-inflammed degenerative tendon).
• biceps tenosynovitis (inflammed tendon sheath).
• ruptured biceps tendon (secondary to degeneration or tear).

Tendons are made up of strands of a material called collagen. The collagen strands are lined up in bundles next to each other. Because the collagen strands in tendons are lined up, tendons have high tensile strength. This means they can withstand high forces that pull on both ends of the tendon. When muscles work, they pull on one end of the tendon. The other end of the tendon pulls on the bone, causing the bone to move.

​The biceps muscle is in the front of your upper arm. It has two tendons that attach the biceps muscle to bones in the shoulder.
​The long head attaches to the top of the shoulder socket (glenoid).
The short head of the biceps tendon attaches to a bump on the shoulder blade called the coracoid. 

Bicep Tendinitis

​A biceps tendon injury is damage to the long head of the biceps tendon. 

Tendinopathy is generally caused by overuse of a muscle and tendon. However, shoulder tendinopathy can also be caused by:

• Inflammatory disease in the shoulder, such as arthritis.
• Trauma to the shoulder.
• Fall on outstretched arms.
• Normal wear and tear associated with age.

Symptoms:

A Biceps tendon injury may be felt as a severe or sharp pain in the front of the shoulder during the early stages and sometimes as a ‘‘dull ache’’ once it has been present for some weeks. The area may be tender, red, warm, or swollen if there is inflammation.  There may be stiffness and loss of strength and pain can also extend down into the biceps muscle in the arm. A catching or slipping sensation felt near the top of the biceps muscle may suggest a tear. 

Biceps tendinopathy is rarely seen in isolation. Because it is caused by overuse, tendon impingement, shoulder joint instability or trauma it usually coexists with other shoulder injuries, such as rotator cuff impingement syndrome, rotator cuff tears, labral tears, SLAP lesions and shoulder instability. 

​ Tendinitis: This term refers to friction and irritation to the tendon accompanied by inflammation. The suffix 'itis' means inflammation. When your muscles move in new ways or do more work than they can handle, your muscles and tendons can sustain damage that can result in irritation or actual tears, causing immediate pain and inflammation.  
If the increase in demand is made gradually, muscle and tendon tissues will usually heal, build in strength, and adapt to new loads.

Tendinosis: This is an accumulation of microtears in the connective tissue in and around the tendon at a cellular level, caused by microscopic injuries not having healed properly over time or from degenerative changes through ageing.  Although inflammation can be involved in the initial stages of the injury, it is the inability of the tendon to heal that perpetuates the pain and disability. When enough injury accumulates, you will feel pain. This kind of injury that comes on slowly with time and persists is a chronic injury.  
​Tendinosis may lead to reduced tensile strength, thus increasing the chance of tendon rupture. 

Tenosynovitis: This is an inflamed tendon sheath and is more common in the tendons of the wrist, hands, and feet. ​A protective sheath known as the synovium covers tendons. This sheath produces synovial fluid, which keeps the tendon lubricated. Injury to the tendon may result in the malfunction of the sheath. If this occurs, the sheath may fail to make synovial fluid or it may not make enough fluid. This can cause inflammation or swelling of the sheath.

​Rupture: Occasionally, damage to the tendon can result in a tendon rupture, creating a "popeye" bulge in the upper arm.

Avoiding Injury:

The best treatment is prevention. It is important to avoid or alter the activities that cause the problem. When doing physical activities, take it slowly at first and gradually build up your activity level, limit the number of repetitions you do and the amount of force you use, and stop if you feel any unusual pain. Be careful to avoid and then correct underlying conditions such as improper posture or poor technique in sports or work.

Treatment:

A bicep tendinopathy diagnosis is based on your symptoms, history and a clinical examination. Treatment is then based on the type of tendinopathy you present with. However, we will also need to address the cause of your tendinopathy since this condition is rarely an isolated injury.

Due to its inflammatory nature, tendonitis may respond favourable to non-steroidal anti-inflammatory medications (NSAIDs), including common over-the-counter drugs such as ibuprofen.  Ice is also recommended to relieve pain and reduce swelling.

In rare instances, a cortisone injection may be used to try to control pain.  However, cortisone is a very powerful steroid and is used very sparingly because it can weaken the biceps tendon, and possibly cause it to rupture.

​Because Tendinosis has no inflammation it is unlikely to respond to (NSAIDs).  We can advise you on suitable tendon strengthening exercises that are more beneficial.

​In the early phase of your injury you’ll most likely be unable to fully lift your arm or sleep comfortably. The first aim is to provide you with some active rest from pain-provoking postures and movements. This means that you should stop doing the movement or activity that provoked the shoulder pain in the first place and avoid doing anything that causes pain in your shoulder.

​We will will utilise a range of pain relieving techniques including joint mobilisations, massage, acupuncture or dry needling to assist you during this phase of treatment.

​We will assess your muscle and joint flexibility and prescribe exercises or recommend massage to attain normal range of motion.

​We will also assess your shoulder stability and movement function and advise suitable exercises, which may include:

• Biceps strengthening
• Rotator cuff strengthening.
• Scapular stabilisation: strength and rhythm.

Patients who are improving with conservative treatments do not typically require surgery. Surgery may be recommended if the problem doesn't go away or when there are other shoulder problems present.

It is important that you understand why you have developed bicep tendinopathy. We will discuss with you about which activities and postures are likely to aggravate your condition and if necessary help you to modify your technique or training/work volume.

​Depending on the demands of your chosen sport or your job, you will require specific exercises and a progressed rehabilitation regime to enable a safe and injury-free return to your chosen sport or employment.

​There is no specific time frame for when to progress from each stage to the next. Your injury rehabilitation status will be determined by many factors based on your clinical assessments.

Give us a call at NorthWest Physio + and let us help you get back to full function.

Call 09 412 2945 now or leave your contact details at any time on our contact page or make an appointment via our online booking service.