Biceps Tendinitis

• Pain: Dull, aching pain in the front of the shoulder that can radiate down the upper arm. Pain that worsens with activities that involve overhead movements, reaching behind, or rotating the shoulder.
• Weakness: Shoulder and upper arm weakness that makes it difficult to perform daily tasks such as lifting objects or reaching for items.
• Tenderness: Noticeable tenderness and discomfort around the tendon especially when pressing on the front of the shoulder.
• Swelling: Mild to moderate swelling in the affected area that increases with repetitive strain.
• Snapping sensation: Snapping sound or sensation when moving the shoulder, particularly when raising the arm or rotating it inward. This sensation is caused by the tendon moving abnormally within the shoulder joint.
• Range of motion: Reduced range of motion especially when attempting to lift the arm above the head or behind the back.

• Repetitive overhead activities: common in athletes who participate in sports like swimming, tennis, baseball, and weightlifting. the repetitive nature of these movements can strain the tendon over time, leading to microtears and inflammation.
• Overuse or overexertion: activities that involve frequent lifting, pulling, or pushing can place excessive stress on the biceps tendon, causing irritation and inflammation.
• Sudden injury: acute injuries, such as falling on an outstretched arm or lifting a heavy object improperly, can cause immediate damage to the tendon.
• Age-related degeneration: as people age, tendons naturally weaken and lose elasticity, making them more susceptible to injury and inflammation. this degeneration can lead to tendonitis, especially in individuals over the age of 40.
• Poor posture: slouching or maintaining improper posture for extended periods can place stress on the shoulder and biceps tendon, contributing to inflammation.
• Other shoulder conditions: conditions such as rotator cuff injuries, shoulder impingement, or arthritis can increase the risk of developing biceps tendonitis, as they alter the normal mechanics of the shoulder.

Dr. Cinque will review your medical history, inquire about your symptoms and when they began. He will perform an orthopedic examination assessing the shoulder’s tenderness, range of motion, strength and stability. He will also perform specific tests or ask the patient to perform specific movements to assess pain and identify the location of inflammation. Dr. Cinque may also order an X-ray to evaluate the bone and possibly an MRI or ultrasound to view the soft tissue including the biceps tendon and muscle. This will help to confirm the diagnosis and rule out other conditions such as rotator cuff tears or arthritis, which can contribute to biceps tendonitis.

Nonsurgical conservative management

This involves rest, activity modification, icing and over the counter anti-inflammatory drugs (NSAIDS) applied topically or taken orally. Physical therapy, and corticosteroid injections for pain relief when inflammation is severe and does not respond to other treatments.

Surgery

When pain fails to improve, and interferes with sleep, dressing and doing a job, Dr. Cinque may recommend a minimally invasive surgical procedure to view the tendon directly and assess its condition along with evaluating other shoulder structures that could be involved. If you also have a rotator cuff tear or other tendon damage surgery will be recommended.

• Biceps tenodesis: The surgical procedure is called a biceps tenodesis. In this procedure the damaged part of the tendon is surgically removed and reattaches the remaining tendon to the upper arm bone. This usually resolves symptoms and restores function. This procedure can also treat SLAP tears of the shoulder labrum. Full recovery takes 4-6 months.
• Biceps tenotomy: This surgical procedure is recommended when the long head of the biceps tendon is so damaged that it cannot be treated with tenodesis. Here Dr. Cinque will cut the tendon at its base and allow it to retract out of the shoulder joint. This will result in a Popeye bulge in the arm. However, it offers good pain relief allows the biceps to function normally. The bulge is generally not a problem for many people. However, it can be a problem for active individuals who may prefer a tenodesis. Recovery typically takes 3-6 months.

Physical therapy is vital to full recovery from shoulder surgical procedures for biceps tendonitis.