Tendinitis is the inflammation, irritation or swelling of a tendon. A tendon is what attaches a muscle to the bone. The biceps muscle runs down the front of the arm from the shoulder to the elbow, and it’s primary function is to flex (bend) the elbow and supinate the forearm (rotate the hand to palm-up position).
Most commonly, this is an overuse injury, caused from chronic repetitive use. As an overload is placed on the tendon, it leads to microscopic tears, which in turn cause inflammation. The demand that is placed on the muscle and tendon with overhead throwing makes baseball and tennis players especially at risk. Swimmers also frequently find this a problem. Athletes that perform large numbers of repetitive lifting such as bench press and dips may suffer as well. Fast pitch softball pitchers are particularly liable.
As we age, our tendons lose some of their elasticity, and these degenerative changes may predispose someone to injury. Systemic diseases such as rheumatoid arthritis or diabetes may also be a risk factor.
The primary symptom of bicipital tendinitis is pain in the anterior shoulder and often down the front of the arm to the elbow. The first sign is usually pain in the shoulder after activity. As the condition progresses, there may be pain at the beginning of the workout, or activity, which may resolve as you warm up, only to return again after your done. At this stage, your activity and strength is not yet restricted. As you continue to overstress the area, causing more microtearing and resulting inflammation, you may find you have pain now during your entire activity or workout, and persists into the night. You may now find this pain restricts your activity. As this condition continues to progress, there may be pain with everyday activities.
Signs & Tests:
Localized tenderness is usually present right over the tendon as it runs through the bicipital groove (in the front part of the shoulder).
Resisted muscle testing of the biceps muscle will often be painful. There is specific muscle and joint testing that can be done by a physician or physical therapist that can help to differentiate between bicipital tendinitis and other conditions that also cause shoulder pain. Rotator cuff injury, labral tears, impingement syndrome and cervical spine disease, are a few conditions that can cause shoulder pain as well. X-ray, MRI, and EMG studies may help to rule out some of these conditions.
The primary goal of treatment is the three R’s:
- Relieve pain
- Reduce inflammation
- Return to activity
The first step is to rest the area and ice often. This will help to reduce the inflammation and pain. It is important to avoid any activity that causes pain.
Your physician to help ease pain and decrease inflammation in order to allow physical therapy to begin may prescribe a non-steroidal anti-inflammatory medication (NSAIDs) or steroid injection.
Physical therapy will help to stretch and strengthen the biceps muscle and tendon, as well as address the surrounding areas as well. For example, there may be weakness in the muscles that stabilize the scapula (shoulder blade), or rotator cuff muscles. Cross-frictional massage, a form of deep tissue massage may help to break up adhesions and scar tissue that has formed along the tendon sheath. Normal range of motion should be restored and maintained. Sport or activity specific exercises should be performed. A physical therapist can help to teach proper mechanics and exercise technique in order to prevent this injury from happening again. One thing that is important to remember is, do not ignore or try to work through shoulder pain.
If you are having any shoulder pain, now is the time to check it out! Give us a call.
Sequeira, K. MD. E-Medicine. 7/12/2004.
Lillegard, Butcher & Rucker. Handbook of Sports Medicine. Butterworth-Heinemann. 1999.
Wood, D. RN . Health One Centennial Medical Plaza. 8/2003.