By Sydney CBD Osteopath Dr Marcus Ng
Deep, throbbing pain in the front of the shoulder? Made worse with lifting? This is a typical presentation of Bicep tendinopathy. In this blog we will discuss… What is Bicep tendinopathy? The causes of Bicep tendinopathy? Signs and symptoms of Bicep tendinopathy? What you can do right now to help a biceps tendinopathy? How a physio or osteo can help your Bicep tendinopathy? And how long it takes for Bicep tendinopathy gets better.
A Bicep tendinopathy is simply a disorder or a disease of the bicep tendon denoted in the suffix, -pathy. This may include tendonitis (inflammation) or tendonosis (chronic) type injuries. This is where there is damage to fibers of the tendon.
The bicep brachii is the muscle in your arm and has two muscle bellies. Each of these muscles is connected to the bone via a tendon. At the shoulder, the short head of the biceps is attached to coracoid process of the scapula (shoulder blade). The long head of bicep attaches to supraglenoid tubercle of the scapula, deep inside the shoulder joint. The two bicep bellies share a single tendon at the elbow region and that attaches to the radial tuberosity of the radius, the outside bone of the forearm.
With a Bicep tendinopathy, we are dealing primarily with the tendon of the long head of bicep. The tendon connected to the long head belly runs along the bicipital groove at the front of the upper arm bone before it travels below the subacromial space at the tip of the shoulder before diving deep into the shoulder joint to attach to the supraglenoid tubercle.
The function of the bicep is to flex the arm at the elbow joint and also stabilize the front of the shoulder. So you can imagine the bicep has a crucial role to play involving any elbow movement and shoulder stability.
With regards to daily activities, Bicep tendinopathy most commonly occur with overhead ball sports, swimming, gymnasts, contact sports and even in individuals would does lots of weight training. Occupations that require similar types of heavy and/or repetitive activities in said position are also likely to experience Bicep tendinopathy.
The causes of Bicep tendinopathy can occur in a variety of ways. A tendon tear can occur even with a healthy tendon if there is a high impact, sudden and overloaded force going through it such as a throw or a sudden drop of a heavy weight. Another way a Bicep tendinopathy can occur is with repetitive overuse activity leading to the actual tissue cell degeneration of the tendon. In this case, inflammation will occur in response to the damage, the tissue then rebuilds, remodels and regenerates to become healthy tissue once again. Lastly, Bicep tendinopathy can occur via direct trauma, such as a collision in a tackle sport or in rarely cases some type of laceration such as a knife wound.
There are a number of different presentations of Bicep tendinopathy. Pain is most commonly felt in the front of the shoulder, it can be felt with or without arm movement. It can be localized in the groove of the front shoulder arm or it can be vague and broad throughout the whole upper arm. Depending on the type of tendon injury, some clicking or snapping sensation maybe felt with shoulder and elbow movement as well, particularly with overhead movements.
It is important to know Bicep tendinopathy can commonly present as a result of, or in conjunction with, other shoulder conditions/injuries such as rotator cuff tears and SLAP lesions; therefore it is sometimes necessary to address other factors relating to the shoulder girdle as a whole to resolve and prevent bicep tendon injury from returning.
There are several things you can do immediately after suffering from Bicep tendinopathy. First is to rest and not do any activities or put the shoulder in any position that exacerbates the pain. If there are signs of inflammation, using ice for 20min on, then off, then 20min on again is a great way to reduce the inflamed tissues in the shoulder. Short-term use of medication such as NSAIDs is an option, however it should not be a substitute for prolonged relief.
Seek further investigation with your physio or osteo should the condition not improve. Living with Bicep tendinopathy can drastically diminish your quality of life, as you will find yourself having difficulty with reaching, putting on clothes or carrying even seemingly light objects.
Manual therapy and exercise rehab is the best form of treatment of Bicep tendinopathy. Your practitioner will first take a thorough history of the injury which includes how and when it may have occurred, and any pre-existing conditions that may contribute to the injury.
There are a number of orthopedic tests available to test for Bicep tendinopathy. The most common and useful include the Speed’s, Yergason’s and Bicep Load 2 tests. Imaging such as ultrasound and MRI can be use to confirm severity should the orthopedic test be inconclusive.
Because a tendon sits between its muscle belly and the bony attachment, we can use muscle tear grading to further rate of level of injury:
– Grade 1 is a mild with minimum loss of strength and motion. Inflammation of irritated surrounding tissues can be present.
– Grade 2: is a significant loss of strength and motion. These injuries may require two to three months before a complete return to athletics.
– Grade 3: complete rupture of a tendon or muscle. In most cases of complete ruptures, surgery is often required.
It depends on the type of injury and/or the severity, but it typically ranges from 1 week to 3months. A low grade muscle tear will be drastically quicker then say a SLAP tear. Generally speaking, if surgery isn’t required, once the acute phase of pain has settled, exercise rehab can begin. A further decrease in pain as well as improvement in function will set the tone of the intensity and frequency of exercise rehab.
As previously mentioned, it is important to also address other greater shoulder complex issues to ensure the best motor pattern moving forward. This will ultimately minimise the chance of the Bicep tendinopathy from returning all together.