Your biceps tendon is located in the front part of your shoulder and upper arm. Bicep tendonitis, more correctly termed tendinosis, refers to inflammation, pain, or tenderness in your biceps tendon.
How You May Develop Bicep Tendonitis
You can develop bicep tendonitis from acute or chronic stress on your rotator cuff tendons. This usually happens if you do a lot of repetitive overhead reaching or excessive weight training. You can also get bicep tendonitis if you have multi-directional instability, calcifications in your tendon, or experience direct trauma.
Your biceps tendons can become inflamed from years of shoulder wear and tear. If you have bicep tendonitis, your doctor will likely find signs of degeneration in your tissues. When your tendon degenerates, the collagen fibers that join together to form your tendon lose their normal arrangement. When this happens, individual strands of your tendon become frayed and break, weakening your tendon. This could cause your tendon to eventually rupture.
Because your bicep tendon attaches inside your shoulder through a small hole in your rotator cuff, bicep tendonitis is usually associated with rotator cuff pathology.
Symptoms of Bicep Tendonitis
If you have bicep tendonitis, you’ll feel pain when you touch the front of your shoulder or during certain activities, such as throwing. You’ll also feel pain when you move your arm and shoulder, especially when you lift your arm above shoulder height.
How Your Doctor Will Diagnose Bicep Tendonitis
Your doctor may diagnose you with rotator cuff or bicep tendinosis by using a stress test. If you have bicep tendonitis, the test will elicit pain or weakness in your rotator cuff muscles.
There are two common tests your doctor might use to diagnose tendonitis: the Neer Test and the Hawkins Test. With the Neer Test, you’ll feel pain when your shoulder is passively abducted to 180 degrees. You’ll feel pain during the Hawkins Test when your shoulder is passively flexed to 90 degrees and rotated internally.
Treating Your Tendonitis
To treat your bicep tendonitis, you may need to use:
- rest and ice to control inflammation—apply ice for 20 to 30 minutes every 3 to 4 hours for 2 or 3 days or until the pain goes away
- anti-inflammatory medications
- cortisone injections
- physical therapy and rehabilitation exercises
If you pay attention to the signs and symptoms of tendonitis and address the problem early, your body should respond to non-surgical therapy. However, you may need surgery if the problem doesn’t go away after you try these treatments. You may also need surgery if you have a chronic condition or other shoulder problems.
Surgery for Your Bicep Tendonitis: Acromioplasty
The most common surgery you might undergo for bicep tendonitis is acromioplasty. It’s most commonly used when your underlying problem is shoulder impingement. If you have acromioplasty, your surgeon will remove the front portion of your acromion, which is the bony ledge where your scapula meets the top of your shoulder joint. Removing a small portion of your acromion creates more space between your acromion and humeral head. That lessens the pressure on your bicep tendon and soft tissues located in between your acromion and humeral head.
Everything You Should Know About Acromioplasty
Acromioplasty is a relatively simple procedure for a skilled orthopedic surgeon. Your surgeon will likely use an arthroscope to perform the surgery. He or she will make a small incision in the skin over your shoulder joint. Then your surgeon will use the arthroscope to locate your deltoid muscle on the outer part of your shoulder. Your surgeon will then split the front section of your deltoid so that your acromion is visible.
Depending on your surgeon, he or she may also detach your deltoid muscle from where it connects to the front of your acromion. Your surgeon will then remove your bursa sac, which lies just under your acromion. After removing your bursa sac, your surgeon will use a surgical tool to cut a small portion off the front of your acromion. This creates the required space between your acromion and humeral head. Your surgeon may also remove the ligament that arcs from your acromion to your coracoid process, called the coracoacromial ligament.
Next, your surgeon will use a surgical file to shave the undersurface of your acromion to remove any bone spurs. Your surgeon will then drill a series of small holes into the remaining acromion so that he or she can reattach your deltoid muscle to your acromion. At this stage, your surgeon will also inspect your rotator cuff muscle to see if there are any tears since many of these injuries tend to go hand in hand. If there are no rotator cuff tears, your surgeon will attach the free end of your deltoid muscle to the ridge of your acromion through the drill holes.
Surgery for Your Biceps Tendonitis: Biceps Tenodesis
If your biceps tendon has severely degenerated or if you need shoulder reconstruction for a different problem, your surgeon may perform biceps tendinosis. Biceps tendinosis is a method of reattaching the top end of your biceps tendon to a new location.
The most common method of bicep tendinosis that your surgeon may use is called the keyhole technique. It’s called this because your surgeon will use a burr to make a small hole, the size of a keyhole, in your humerus. Your surgeon will then slide the end of your tendon into that hole. Then your surgeon will pull your tendon down to anchor it in place. Before performing the reattachment, your surgeon will prepare your tendon by cutting away any frayed and degenerated tissue.
Once prepared, your surgeon will roll the top end of your bicep tendon into a ball. He or she will then use sutures to ensure that the ball keeps its shape, after bending your elbow to remove tension from your tendon. Your surgeon will push the tendon ball into the top part of the keyhole. Next, your surgeon will gradually straighten your elbow. As this happens, the tendon ball will be pulled into the narrow slot in the lower end of the keyhole and become set in place. Finally, your surgeon will complete the procedure by closing the incision with sutures.
Recovering from Your Surgery
Everyone recovers from injuries at a different rate. Like with all overuse injuries, your recovery time will depend on many factors such as your age, health, the severity of your injury, and whether you’ve had a previous injury.
During your recovery, you’ll want to control the pain and inflammation with ice, rest, and anti-inflammatory medicines. Your surgeon will likely want you to start a gentle range-of-motion program soon after your surgery. Once your surgeon clears you, you should do your program every day for the first week after your surgery. This will help you maintain blood flow and help prevent blood clots. Your rehabilitation protocol and restrictions may vary based on the extent of your tendon repair and other factors. Therefore, you must discuss your personal rehabilitation protocol with your surgeon.
You’ll likely begin physical therapy 3-4 days after your surgery, under the direction of your surgeon. It’s very important that you start therapy when your surgeon tells you to and follow the recommended rehabilitative protocols in order to maximize your recovery. Your physical therapy program is vital to your recovery and increasing your muscle strength and range of motion during the recovery process. You may need to continue your physical therapy along with any assigned home strengthening exercises for 6-8 weeks after your surgery.
Your first few therapy sessions may involve nothing more than a passive range of motion exercises. Afterward, you may receive ice and electrical stimulation treatments to help control pain and swelling from your surgery. If you’re experiencing muscle spasm and significant pain, your therapist may also use massage and other types of hands-on treatments to ease these symptoms.
Range of Motion (ROM) Exercises
Once your pain and swelling have subsided, your physical therapy program will help you gradually increase your range of motion (ROM). As part of your program, you’ll likely do exercises to help you improve movement in your forearm, elbow, and shoulder. You should be careful while you’re performing ROM and strengthening exercises and avoid doing too much too quickly. Your ROM exercises will most likely include:
- passive ROM for elbow flexion and supination (with your elbow at 90 degrees)
- assisted ROM for elbow extension and pronation (with your elbow at 90 degrees)
- shoulder ROM as needed based on an evaluation, avoiding excessive extension
During the first few weeks of your strengthening program, you’ll most likely be limited to:
- sub-maximal pain-free isometrics for your triceps and shoulder musculature
- sub-maximal pain-free biceps isometrics with your forearm in neutral
After four weeks, your rehabilitation protocol will likely include:
- active-assisted ROM elbow flexion
- gradual active exercises to strengthen and stabilize your elbow and shoulder muscles and joints (it generally takes three to four months, however, to safely begin doing forceful biceps activity after surgery)
- single plane active ROM elbow flexion, extension, supination, and pronation
- progressive resisted exercises for elbow flexion, extension, supination, and pronation
Don’t Rush Your Recovery Time
The point when you can return to normal activities after your surgery will be determined by how quickly your tendon recovers, not by how many days or weeks it has been since your injury occurred. You need to stop doing any activities that cause pain until your tendon has healed. If you continue doing activities that cause tendon pain, your symptoms will return and it will take you longer to recover. In general, the longer you have symptoms before you start treatment, the longer it will take you to get better. You may recover from a mild injury within a few weeks, but it may take you 6 weeks or longer to recover from a severe injury. You should be able to start light upper extremity weight training after 12-14 weeks, though.
If you experience persistent pain and weakness, it may be a sign of a serious bicep strain or a tearing of the tendon attachment in your shoulder joint. Such a serious injury may require further surgery. So, if you experience persistent pain and weakness during or after your rehabilitation program, be sure to have your surgeon reevaluate your injury.
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