Biceps tendonitis (also referred to as bicep tendinitis) is marked by inflammation of the tendon tissue. This inflammation can lead to a thickening and swelling of the tendon sheath (the outer membrane containing the cord-like tendon fibers). These changes in the tendon’s shape can also affect the mechanics of the shoulder joint, leading to popping or snapping sensation when you attempt to lift your arm above your head or otherwise use the joint.
Our bicep is one of four muscles alongside the brachialis, brachioradialis, and coracobrachialis muscles that make up the upper arm. Generally, the biceps muscle is comprised of two heads. At each end are connective tissues called tendons that anchor the muscles to the bone:
The coracoid process (short head)
The coracoid process of the bicep tendon attaches the back of the upper biceps to a bony protrusion on the shoulder blade (in your upper back). This attachment point plays a role in your arm’s ability to swing across the body and out to the side. Here, the biceps and the biceps tendon also stabilize the shoulder when you lift something heavy.
The glenoid (long head)
The glenoid of the bicep tendon attaches the front of the upper biceps to the top of your shoulder socket. This attachment point helps to stabilize the shoulder by keeping the ball of your humerus inside the socket of the shoulder joint. If tendonitis turns into a full tear at the long head, you may have general biceps weakness, along with difficulty rotating your upper arm (palm up or palm down).
With these two together, the attachment points firmly secure the muscle to the bone, allowing you to flex your arm (bend it at the elbow), rotate your forearm, and swing your arm out to the side or across your body. Most cases of upper biceps tendonitis affect the long head of the bicep tendon (where the muscle attaches to the anterior, or front, of the shoulder). The glenoid is more likely to suffer damage due to its location, crossing in front of the ball-and-socket joint. Thus, any injury affecting the shoulder, such as a forceful dislocation, can put tension on the tendon, leading to irritation or tears.
Causes & Symptoms of Bicep Tendonitis
Bicep tendonitis can develop for many reasons, including regular wear and tear over the course of a person’s life that leads to either a bicep tendon strain or a bicep tendon tear. Other common causes are repetitive movements or overuse injuries as a result of sports or vocational activities.
Injuring the biceps tendon by falling, lifting a heavy object improperly, vehicle accidents, or even other issues, like a rotator cuff tear, can also cause bicep tendonitis. Another known region that is caused by tendonitis is the distal bicep tendon. This region refers to tendonitis pain at or near the elbow.
In rare cases, lifting heavy objects can result in a distal bicep tendon tear. This is a serious injury that causes the muscles to separate from the bone and retract back toward the upper arm. While a patient with a torn distal bicep tendon can still use his or her arm, there will be a loss of strength in motions that require palms-up rotations, like using a screwdriver or other tools.
Symptoms typically present as intermittent or constant shoulder pain in the front side of the shoulder, with radiating (moving) pain down the arm towards the elbow. This pain may worsen when you extend the affected arm out in front of your body or when raising the arm above your head.
In addition, the front of the shoulder may be tender to the touch. Occasionally, damage to the biceps tendon causes a tear or rupture, resulting in a deformity of the upper arm known as a “Popeye” bulge. Other symptoms linked to bicep tendonitis include:
- Pain or soreness at the front of the shoulder.
- Decrease in range of motion in the arm and shoulder.
- A cracking or snagging sensation when using the shoulder and arm.
- Discomfort that may run down the arm and worsen at night or with activity.
As with any injury similar to shoulder tendonitis or hamstring tendonitis, pain, discomfort, and a lack of physical capacity can be stressful and affect your daily lifestyle.
Who gets Bicep Tendonitis?
Bicep tendonitis may be grouped into two major areas, which are traumatic injuries and degenerative injuries. While traumatic injuries are one-time events, often unforeseeable accidents, the degeneration can occur over time. Patients with bicep tendonitis tend to have one or more of the following risk factors, such as:
- Age – Degenerative injuries tend to occur in patients over the age of 40 and become increasingly more common as people continue to age. The average range of years is between 40 and 70 who are most susceptible to bicep tendonitis.
- Other shoulder conditions – such as osteoarthritis of the shoulder, shoulder impingement, or rotator cuff injuries can accompany tendonitis or make its occurrence more likely.
- Overuse – Degenerative injuries are more common in people who engage in repetitive overhead shoulder motions, such as hammering, painting, swimming, playing tennis, or pitching a baseball.
- Sports / occupation – Frequent, repetitive use of the shoulder, especially overhand motions or lifting heavy items overhead, can increase your risk of developing bicep tendonitis.
- Smoking – Smoking has been associated with an increased risk of tendon damage and rupture, along with slower healing due to poor circulation.
- Obesity – Being significantly overweight may make you more likely to experience collagen breakdown.
How Does Bicep Tendonitis Affect You? How Serious is it?
Without treatment, biceps problems may lead to permanent loss of motion or even weakness and may result in progressive degeneration of the biceps. Although resting your upper arm is necessary for your recovery, keeping your upper arm immobilized for a prolonged time may cause the connective tissue enclosing the joint to become thickened and tight.
In addition to complications associated with biceps tendonitis, as with any surgery, the procedure to correct bicep tendonitis involves some risks, including:
- Nerve or blood vessel damage – During surgery, there is a slight chance the nerves, veins, or tissue around your shoulder can be damaged. Damaged nerves or blood vessels can cause numbness, pain, or lower blood flow around the affected shoulder.
- Blood clots – Because biceps surgery affects the way blood flows around the area, it can increase your risk of developing blood clots.
- Longer-term upper arm stiffness – Longer-term upper arm stiffness is usually caused by excessive scar tissue. Oftentimes, lack of use or exercise can cause scar tissue to build up in the soft tissue around the joint.
- Persistent biceps pain – Some patients tend to continue to have persistent biceps pain after surgery.
Recommended Treatment & Rehabilitation for Bicep Tendonitis
If you are having symptoms of bicep tendonitis, it is recommended to visit a doctor as he / she will perform a thorough physical examination by bending to examine your biceps and the rest of your upper arm. You will be checked to see where you are feeling pain and tenderness.
Your doctor will also test your range of motion by asking you to move your arm in certain directions. You may also be asked to test the strength of your shoulder joint by pressing against their hand. They will finally examine your neck to check your conditions such as arthritis which can cause symptoms similar to bicep tendonitis.
Afterward, your doctor may order additional imaging tests to confirm the diagnosis of the condition and help rule out any other causes of your symptoms. An X-ray may be ordered to see if you have a bone spur.
He or she may also order an ultrasound or magnetic resonance imaging (MRI) scan to precisely check for inflammation in your biceps and signs of any tearing. It is important to get proper treatment for tendonitis as soon as it occurs. Over time, a degenerated tendon that isn’t treated can begin to tear, causing a more serious condition.
Physiotherapy can be very successful in treating bicep tendonitis, and other shoulder conditions. Therefore, you will work with a physiotherapist to devise a treatment plan that is specific to your condition and goals. This treatment program may include the following:
Pain management
Your physiotherapist will help you indent and avoid painful movements to allow the inflamed tendon to heal. Ice, massage, or moist heat may be applied for pain management. Therapeutic modalities, such as electrical stimulation (TENS) may be applied.
Patient education
Posture education is an important part of rehabilitation. For example, when you roll forward as you lean over a computer, the tendons in the front of the biceps can become pinched. Your physiotherapist may recommend adjustments to your workstation and work habits. Your physiotherapist will also instruct you in ideal sitting, standing, and sleeping positions to help alleviate symptoms. Your therapist may suggest different ways to perform currently painful activities and show you movements to avoid while the bicep is in a painful condition.
Range-of-motion exercises
With your physiotherapist, you will learn exercises and stretches to help your shoulder and shoulder blade move properly, so you can return to reaching and lifting without pain.
Functional training
As your symptoms improve, your physiotherapist will help you return to your previous level of function, which may include household chores, job duties, and sports-related activities. Functional training can include working or lifting a glass into a cupboard or throwing a ball using proper upper arm mechanics.
Manual therapy
Your physiotherapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and shoulder stretches, to get your arm moving properly again.
Performing the correct exercises for bicep tendonitis is important during recovery; since these muscles are essential for everyday function. Here are some exercises for a rapid bicep recovery:
Bicep curls
Stand upright with your injured arm hanging at your side, palm facing out. Next, gently bend your injured arm at the elbow, bringing your palm toward your shoulder. Hold this bend for 30 seconds, then slowly release it back to the starting position. Repeat this method 3-4 times a day.
Biceps stretch
Stand six inches in front of a wall and hold your injured arm out horizontally just below shoulder height. Then, place the side of your thumb against the wall, keeping your hand palm-down. Gently turn away from the wall in the opposite direction from your arm until you feel a good stretch, then hold for 15 seconds before repeating 3-4 times a day.
Forearm twists
Allow your injured arm to hang at your side, then bend your elbow to a 90-degree angle. Next, turn your palm so it faces upward, and hold the position for 5 seconds. Rotate your palm so it faces downward and hold the position for 5 seconds. Repeat this exercise 3-4 times a day.
Alternative & Homeopathic Treatment for Bicep Tendonitis
There are several ways for you to alleviate your biceps pain. The key to this process is understanding that some movements and exercises can be very helpful, while others can harm your upper arm. Here are some homeopathic treatments to help relieve your biceps tendon pain:
Cold therapy
Applying ice reduces blood flow, which will decrease inflammation and swelling, and alleviate pain in the process; cold therapy is recommended immediately after pain strikes, and ice packs should be applied for 15-20 minutes, up to 5 times a day.
Heat therapy
Applying heat to a painful shoulder increases blood flow and brings in oxygen and nutrients to the area, which will accelerate the healing process and alleviate pain; this is recommended a few days after the onset of pain and can be accomplished with an added hot shower directly on the biceps area or a hot pack applied to the affected area for 15-20 minutes a day.
Over-the-counter medications
Some patients with mild bicep tendonitis can experience relief with pain medications that do not require a prescription, particularly non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen; NSAIDs may alleviate pain by reducing inflammation.
Sleeping style
Sleeping on your bad shoulder can make matters much worse, so it is recommended to try to sleep on your back or the side of your body that is unaffected by shoulder pain to avoid worsening the problem.
Massage therapy
Gently massaging your upper arm will help alleviate stress and tension in the surrounding muscles, while also improving blood circulation and reducing swelling in the process, all of which can reduce your pain levels.