Biceps Tendonitis: Causes, Symptoms, and Treatment

Biceps tendonitis refers to the presence of inflammatory processes in the area of the biceps tendon. In most cases, these inflammatory processes affect the long tendon of the biceps muscle. It is, therefore, not directly an inflammation of the muscle.

Introduction

The biceps (Musculus biceps brachii) is a skeletal muscle in the area of the upper arm. It is composed of two different muscle heads (long head and short head; Caput longum et breve). These two muscle heads originate at different points on the shoulder blade and unite to form a single muscle belly in the middle section of the upper arm.

The biceps are mainly involved in the supination of the forearm (rotation of the forearm so that the thumb rotates around the hand from inside to outside). Besides, the arm can be guided away from the body when the long biceps head is tensed in isolation (abduction). If both heads of the muscle contract at the same time, the arm is guided forward, starting from the basic posture (anteversion). Besides, the biceps are involved in the internal rotation of the arm.

Due to the sometimes heavy loads acting on the biceps, various diseases are particularly frequent in this muscle area. The long tendon, in particular, is subject to specific mechanical stress due to its course through the shoulder joint. For this reason, the long biceps tendon, in particular, is at risk of developing painful fraying or entrapment. In addition to the particularly common rupture of the biceps tendon (rupture of the biceps tendon), an biceps tendonitis tendon can be provoked by regular strength training.

Further risk factors for the development of a biceps tendon inflammation are posture and movement errors, old age, and diseases of the shoulder joint. Persons who suffer from pain in the shoulder and upper arm area over a longer period should consult a specialist as soon as possible. Only early diagnosis and initiation of appropriate treatment can prevent consequential damage to the biceps tendon.

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Causes of biceps tendonitis

The biceps is a muscle consisting of two heads, and its tendon runs through the shoulder joint.

If an biceps tendonitis tendon occurs, the long tendon of the muscle is affected in about 90 percent of cases. Inflammatory processes in the area of the short biceps tendon, on the other hand, are relatively rare. Furthermore, it can be observed that biceps tendon inflammation usually affects the dominant arm.

An inflammation of the long biceps tendon of the muscle is usually accompanied by signs of wear and tear. Especially for people who regularly practice throwing sports (such as baseball or handball), there is an increased risk of developing biceps tendon inflammation. Furthermore, biceps tendon inflammation can often be observed in strength athletes or golfers. The reason for this is the long-term overloading of the biceps tendon. A pre-damage of the long biceps tendon, which can tire after a certain period in a biceps tendon inflammation, is also often caused by a sudden trauma. In particular, severe falls or blunt force trauma in the shoulder joint area can attack the tendon structure and promote the development of biceps tendon inflammation.

Inflammatory processes in the area of the short tendon of the muscle, on the other hand, often develop for no apparent reason. In medical terminology, this is known as idiopathic biceps tendon inflammation.

Another typical cause for the occurrence of inflammatory processes in the area of the long biceps tendon is the so-called “impingement syndrome.” This disease causes a narrowing within the shoulder joint. Especially when the arm is lifted laterally, the humerus is brought too close to the acromion. In this way, the long tendon of the muscle is regularly subjected to considerable stress. Also, biceps tendonitis can occur in the acute phase of so-called “shoulder stiffness” or in rheumatoid diseases of the shoulder.

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Symptoms of biceps tendonitis

In the presence of an biceps tendonitis, the typical signs of inflammation can usually be observed. The affected patients usually feel dull or stabbing pain in the front of the shoulder at a very early stage. These pains often radiate into the neck and upper arm. Besides, a direct comparison of the sides of both arms shows that the shoulder affected by the inflammatory processes is overheated. Due to the relatively deep course of the biceps tendons, swelling and redness only occur in particularly pronounced cases of illness.

People who suffer from biceps tendon inflammation can usually only move the affected arm to a limited extent or not at all. Occasionally, when trying to lift the affected arm sideways, a snapping, jumping, or cracking sound can be heard.

Diagnosis

The diagnosis of biceps tendon inflammation comprises several steps. In the beginning, there is usually a comprehensive doctor-patient consultation (anamnesis), during which the affected patient should describe the existing symptoms as detailed as possible. Already the complaints felt by the patient provide a first indication of the presence of a biceps tendon inflammation.

This is followed by an orienting physical examination comparing the sides of the biceps tendon. If the presence of biceps tendon inflammation is suspected, the doctor will begin with an inspection of the shoulders and arms. He pays particular attention to deformities, skin symptoms (for example, redness), wounds, and scars. The actual examination then begins. There is a variety of special examinations that can help to diagnose pathological changes in the area of the long biceps tendon. Due to the causative diseases, a patient suffering from a biceps tendonitis usually shows a significant restriction of movement in the shoulder joint.

Besides, imaging techniques, in particular, play a decisive role in the diagnosis of biceps tendon inflammation. With the help of an ultrasound examination (sonography), thickenings, and fluid accumulations in the area of the long biceps tendon can be depicted. Magnetic resonance imaging of the shoulder (MRI) of the affected shoulder can help diagnose biceps tendon inflammation.

In addition to the quality and biceps tendonitis, an MRI of the shoulder can also reveal damage to the rotator cuff, cartilage damage in the shoulder joint, and other pathological processes.

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Duration of biceps tendon inflammation

Biceps tendon inflammations can be of very different durations. If you feel pain on your shoulders after a strenuous workout or other special strain, this pain can be quickly relieved with cold applications and immobilization, and the inflammation can be nipped in the bud.

If the inflammation has (un-)noticed already advanced, it can last for weeks or months and, depending on the treatment/immobilization, it can always cause new problems. A complete immobilization of the shoulder region is very difficult in everyday life, and a too-early return to sports activities can lead to a renewed occurrence of the inflammation.

If an operative therapy takes place, a stress-free period of at least two weeks must be assumed after the operation and full weight-bearing of the shoulder only after 8-12 weeks.

Treatment of biceps tendonitis

Painkillers are used for acute complaints.

The treatment of biceps tendon inflammation depends primarily on the underlying cause. Acute complaints caused by the inflammatory processes in the area of the muscle-tendon can be alleviated by taking pain-relieving medication. Painkillers (analgesics) containing the active ingredients paracetamol or ibuprofen are particularly suitable for relieving the symptoms of biceps tendon inflammation. Since the active ingredient ibuprofen has both pain-relieving and anti-inflammatory properties, its use should be preferred.

Also, local cold applications can help to relieve the acute symptoms of biceps tendon inflammation. Patients who suffer from particularly pronounced symptoms can treat the affected shoulder with the help of a cooling pad or cooling cushion. In this context, however, care must be taken to ensure that the coolant is never applied directly to the skin surface. Otherwise, the skin and the tissue immediately below the skin surface may be damaged by the cold.

In the case of a biceps tendonitis, which has developed in the course of the impingement syndrome, in many cases, a surgical correction of the shoulder joint must be carried out. Patients suffering from biceps tendon inflammation should make sure that they do not put any weight on the affected arm for a while. Sports activities should generally be discontinued until the inflammatory processes have healed completely. Otherwise, severe complications may arise, which may require surgical removal of the tendon.

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Physiotherapy

There are various physiotherapeutic treatment options for biceps tendonitis. One of these is conservative therapy through physiotherapy. Therapy aims to restore the full range of motion and freedom from pain in the shoulder joint.

Physiotherapeutic treatment includes, among other things, gymnastics for the shoulder muscles. The patient should be introduced to exercises that serve to build up muscles in the shoulder area. In the long term, these exercises should be carried out regularly on the patient’s initiative to enable muscle growth in the shoulder girdle.

The muscles of the rotator cuff play an important role in this process, as they guide the shoulder blade and can only contribute to relieving the bicipital tendon if they function properly. The triceps is also important at this point.

The mobilization of the corresponding muscles can be carried out passively by the therapist, actively by the patient or by a mixture of both. If it is a biceps tendonitis caused by overstrain, the main focus during physiotherapeutic treatment is on relieving the shoulder joint, accompanied by a break from physical activity.

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Exercises for biceps tendon inflammation

After a biceps tendonitis, physiotherapeutic treatment, in addition to the application of pain and anti-inflammatory ointments, is essential to achieve full functionality and regeneration of the injured tendon.

A typical therapeutic application is the so-called cross friction. This is intended to reduce pain while at the same time increasing mobility.

The friction, i.e., rubbing, should be transverse to the longitudinal course of the tendon. In the case of biceps tendon inflammation, the tendonous part is preferably massaged with the help of the fingers without the person affected feeling pain.

This is intended to promote local blood circulation. In other indications, this method can be used to relieve tension or hardening.

It is important to know that cross friction may only be used in the event of biceps tendonitis. Calcification of the biceps tendon in the approach is considered a contraindication.

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Stretching in case of biceps tendonitis

The treatment of biceps tendon inflammation includes not only drug therapy, pain-relieving therapy in the form of physiotherapy, and prior protection of the affected biceps tendon, but also special stretching exercises.

The stretching of the biceps tendon inflammation should, however, only take place when the acute symptoms in the form of pain, redness, and overheating have subsided.

In the following, three exercises will be explained as examples of stretching the biceps tendon after an inflammatory disease.

In the first exercise, the patient stands with the side of the affected shoulder against the wall or a door frame. The affected arm is stretched backward parallel to the floor and pressed lightly against the wall or door frame until a feeling of stretching occurs.

The arm of the affected side is stretched forward and parallel to the floor, with the palms of the hands facing upwards, so that the palm of the other hand can be pressed slightly towards the floor.

Both arms are brought together behind the back, and the hands are placed inside each other so that the palms of the hands are facing down. Now the arms are stretched away from the body towards the ceiling until a stretch is felt in the biceps.

The stretching exercises should all be held for about 20-30 seconds and repeat several times if necessary. It is important to mention that stretching exercises are generally more suitable for the muscular part of muscles and not for the sinewy part. Nevertheless, the stretching exercises have a positive effect on the therapy of biceps tendon inflammation.

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Swimming in case of biceps tendon inflammation

Swimming is one of the sports in which injuries such as biceps tendon inflammation can occur. The biceps has its origin with the long and the short biceps tendon in the area of the shoulder joint so that a biceps tendonitis is closely related to inflammations in the shoulder joint.

When swimming, the shoulder joint is actively strained, so that overloading or incorrect loading can lead to biceps tendonitis.

Although swimming can be a trigger for the biceps tendon inflammation, swimming can also serve as a low-stress sports activity to maintain mobility in the shoulder joint.

The biceps are involved in the movement of the body during swimming, but the load, in this case, is not comparable to lifting weights to build up the muscles of the biceps.

Also, no forced flexing position in the elbow joint is assumed during swimming, which in turn suggests that after a biceps tendonitis, a slow habituation to movements in the form of swimming should be aimed for.

In general, it is at the individual discretion of the person affected whether the intensity of pain allows moderate swimming or not. However, it is important not to immobilize the joint, but to spare the origin of the biceps tendon in the shoulder joint.

Complications

Biceps tendonitis should be diagnosed and treated promptly. Pronounced inflammatory processes, especially in the area of the long muscle tendon, can otherwise lead to severe complications. The most common complication that occurs in connection with a biceps tendon inflammation is the so-called “biceps tendon rupture” (tear of the biceps tendon).

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Prognosis of biceps tendonitis

Although biceps tendonitis tendon can be quite persistent and, in many cases, persists for several weeks to months, the prognosis for this disease is comparatively good. With timely diagnosis and rapid initiation of a suitable therapy, the biceps tendon inflammation usually heals without consequential damage.

Healing

Biceps tendonitis can be regressed entirely. Healing may take a long time but is usually possible. The healing process needs to identify the underlying problem of the inflammation to choose the right treatment options.

If there is an anatomical change or malposition in the shoulder region that leads to irritation of the biceps tendon, surgical intervention may be necessary to heal the inflammation, as otherwise the inflammation always regresses when physical strain resumes.

If the inflammation is due to increased physical strain, conservative therapies such as physiotherapy, ultrasound, and immobilization can lead to healing of the inflammation.

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