Article by Shane Armfield
What is Bicep Tendinopathy?
Biceps tendinopathy is the umbrella term for biceps injuries that include:
Having said that, old habits die hard, and the conditions have for many years been commonly referred to as biceps tendonitis or tendinitis. Your up-to-date physiotherapist or sports doctor will refer to this group of injuries as biceps tendinopathies or the specific injury itself after they have diagnosed the injury thoroughly.
Where is your Biceps Tendon?
The anatomy of the biceps muscle is important in understanding biceps tendinopathy. The biceps brachii has two heads: short and long heads. It is predominately the long-head of biceps that becomes symptomatic.
The biceps long head passes over the head of the humerus (ball joint) and attaches to the top of the shoulder socket. The long head of the biceps acts as a shoulder joint stabiliser through depression of the humeral head. The biceps tendon travels through the bicipital groove on the front of the shoulder ball, which is where most inflammation - usually friction related - occurs. If inflammation is the cause you will be diagnosed as either a biceps tendonitis or tenosynovitis.
What Causes Biceps Tendinopathy?
Biceps tendinopathy is rarely seen in isolation. It is caused by overuse, tendon impingement, shoulder joint instability or trauma. Therefore, it coexists with other pathologies of the shoulder, including rotator cuff impingement syndrome, rotator cuff tears, labral tears, SLAP lesions and shoulder instability. It is common in sports that involve throwing, swimmers, gymnasts and some contact sports. Occupations that involve overhead shoulder work or heavy lifting are at risk.
What are the Symptoms of Biceps Tendinopathy?
Bicep tendonitis and tendinopathy sufferers will commonly report:
How is Bicep Tendinopathy Diagnosed?
Bicipital tendinopathy diagnosis is suspected by your physiotherapist or doctor based on your symptoms, history and a clinical examination. Ultrasonography and MRI are the best investigations to confirm the diagnosis.
Bicep Tendinopathy Treatment
Treatment is based on the type of tendinopathy but also needs to address the cause of your tendinopathy since this condition is rarely an isolated injury.
Biceps tendonitis / tendinitis (inflammed tendon), Biceps tenosynovitis (inflammed tendon sheath).
Due to the inflammatory nature, tendonitis may respond favourable to non-steroidal anti-inflammatory medications (NSAIDs) or cortisone injections. Ice is highly recommended to relieve pain and reduce swelling.
Biceps tendinosis (non-inflammed degenerative tendon).
Due to the non-inflammatory nature, tendinosis is unlikely to respond to (NSAIDs) or cortisone injections. In fact, they may actually be detrimental and delay healing in tendinosis suffers. These require special tendon strengthening exercises that your physiotherapist will advise.
Ruptured biceps tendon (secondary to degeneration or tear).
Referral to an Orthopaedic Surgeon is recommended, especially if the rupture is recent.
In the early phase 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.
You may need to be have your shoulder specially taped to provide pain relief. In some cases it may mean that you need to sleep relatively upright or with pillow support. Your physiotherapist will guide you.
Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.
Your physiotherapist will utilise a range of pain relieving techniques including joint mobilisations, massage, acupuncture or dry needling to assist you during this pain-full phase.
Patient Education & Technique Correction
It is important that you understand why you have developed bicipital tendinopathy. Your physiotherapist will discuss with you what activities and postures are likely to aggravate your condition. They may also need to modify your technique or training/work volume.
Range of Motion & Flexibility
Your physiotherapist will assess your muscle and joint flexibility and prescribe exercises or recommend massage to attain normal range of motion.
Improve Joint Stability & Strength
Since glenohumeral joint instability is a major cause of bicipital tendinopathy, your physiotherapist will need to address your scapulohumeral and scapulothoracic stability and movement function. Exercises may include:
In severe cases, surgical stabilisation may be required to correct significant passive instability eg previous dislocation.
Neck & Thoracic Posture & Mobility
Your neck and upper back are significantly linked to how your shoulder blade is positioned and controlled. In some cases joint stiffness or pain referred from inflammed neck joints can directly alter shoulder pain and function. your physiotherapist is an expert at the assessment and treatment of neck and upper back dysfunction. Ask them for more specific advice.
Restore Normal Function: Speed, Load, Power & Proprioception
Your physiotherapy treatment will vary depending on the functional requirements that you specifically need for your shoulder.
If your shoulder injury has been caused by sport it is usually during high speed activities, which place enormous forces on your body (contractile and non-contractile), or repetitive actions.
In order to prevent a recurrence as you return to sport, your physiotherapist will guide you with exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.
Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepares you for light sport-specific training.
Bicep Tendinopathy Prognosis
Bicipital tendinopathies are very successfully rehabilitated with a physiotherapist-guided rehabilitation program. Even biceps tendon ruptures do not always require surgery and can be rehabilitated to resume excellent shoulder function.
In general, the inflammatory versions (tendonitis and tenosynovitis) will respond quicker than the degenerative tendinosis, which already has tendon cell death. It is important to rehabilitate these tendon injuries as well as possible since these are the most likely to rupture in the future.
Due to the the cause of tendinopathy usually being coexisting rotator cuff impingement or shoulder instability the timeframe can vary widely.
Return to Sport or Work
Depending on the demands of your chosen sport or your job, you will require specific sport-specific or work-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport or employment.
Your PhysioWorks physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport or work.
The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimised your chance of future injury.
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 during your physiotherapist’s clinical assessment.
You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.
It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration.
For more specific advice about your biceps tendinopathy, please contact your PhysioWorks physiotherapist.
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