LONG HEAD BICEPS TENDINOSIS
What is Long Head of Biceps Tendonitis?
Biceps tendinitis is an inflammation or irritation of the upper biceps tendon. Also called the long head of the biceps tendon, this strong, cord-like structure connects the biceps muscle to the bone in the shoulder socket.
Pain in the front of the shoulder and weakness are common symptoms of biceps tendinitis. They can often be relieved with rest and medication. In severe cases, you may need surgery to repair the tendon.
Common problems of the tendon include:
Long head of biceps tendonitis: Tendon swelling and inflammation can cause pain at the front of the shoulder. Often, people with biceps tendonitis complain of pain at the shoulder moving to the front of the arm.
Biceps tendon subluxation/dislocation: In some people with rotator cuff tears, the biceps tendon may not be held in the groove in the upper arm. The tendon may snap out of the groove. When the tendon is unstable, we call it subluxation; when it snaps out of the groove, we call it dislocation.
Biceps tendon rupture: The tendon can be torn off entirely from its attachment with increasing damage. The tendon retracts back into the arm, causing a bulge in the biceps. It often looks like a ‘popeye’ muscle when flexing the biceps.
What causes Biceps Tendinitis?
In most cases, damage to the biceps tendon is due to a lifetime of normal activities. As we age, everyday wear and tear causes our tendons to slowly weaken. This degeneration can be worsened by overuse — repeating the same shoulder motions again and again.
Many jobs and routine chores can cause overuse damage. Sports — particularly those that require repetitive overhead motion, such as swimming, tennis, and baseball — can also put people at risk for biceps tendinitis.
Repetitive overhead motion may play a part in other shoulder problems that occur with biceps tendinitis. Rotator cuff tears, osteoarthritis, and chronic shoulder instability are often caused by overuse.
How is Biceps Tendinosis treated?
Biceps tendinitis is typically first treated with simple methods. This type of nonsurgical treatment is usually effective in most patients.
Rest. The first step toward recovery is to avoid activities that cause pain.
Ice. Apply cold packs for 20 minutes at a time, several times a day, to keep swelling down. Do not apply ice directly to the skin.
Nonsteroidal anti-inflammatory drugs (NSAIDs). Anti-inflammatory drugs like ibuprofen, aspirin, and naproxen can reduce pain and swelling.
Steroid injections. Steroids such as cortisone are very effective anti-inflammatory medicines. Injecting steroids into the tendon can relieve pain. Your doctor will use these cautiously, however. In rare circumstances, steroid injections can further weaken the already injured tendon, causing it to tear.
Physical therapy. Specific stretching and strengthening exercises can help restore range of motion and strengthen your shoulder.
If your condition does not improve with nonsurgical treatment, your doctor may offer surgery as an option. Surgery may also be an option if you have other associated shoulder problems.
During arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments.
Repair. Rarely, the biceps tendon can be repaired where it attaches to the shoulder socket (glenoid).
Biceps tenodesis. In some cases, the damaged section of the biceps is removed, and the surgeon reattaches the remaining tendon to the upper arm bone (humerus). This procedure is called a biceps tenodesis. Removing the painful part of the biceps usually resolves symptoms and restores normal function.
Depending on your situation, your surgeon may choose to do this procedure arthroscopically or through an open incision.
Tenotomy. In some cases, the long head of the biceps tendon may be so damaged that it is not possible to repair or tenodese it. Your surgeon may simply elect to release the damaged biceps tendon from its attachment. This is called a biceps tenotomy. This option is the least invasive but may result in a Popeye bulge in the arm. Patients who have tenotomy usually do well and return to near normal strength.
Surgical complications. Overall, complication rates are low, and your surgeon can correct them without difficulty.
Possible complications include infection, bleeding, and stiffness. These are more likely to occur in open surgical procedures than in arthroscopic surgeries.
Rehabilitation. After surgery, your doctor will prescribe a rehabilitation plan based on the procedures performed. You may wear a sling for a few weeks to protect the tendon repair.
Your doctor may restrict certain activities to allow the repaired tendon to heal. It is important to follow your doctor's directions after surgery to avoid damage to your repaired biceps.
Your doctor will soon start you on therapeutic exercises. Flexibility exercises will improve range of motion in your shoulder. Exercises to strengthen your shoulder will gradually be added to your rehabilitation plan.
Surgical outcome. Most patients have good results. They typically regain full range of motion and are able to move their arms without pain. People who play very high-demand overhead sports occasionally need to limit these activities after surgery.