Shoulder and Elbow

Biceps Tendinitis

Anatomy

The shoulder is a complex, ball-and-socket joint made up of three bones: the upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle). The ball, or head, of the upper arm bone fits into a rounded socket (glenoid) in the shoulder blade. The shoulder socket (glenoid) is lined with a strong cartilage (labrum) that cushions the shoulder joint and adds stability.

The arm bone is kept centered in the shoulder socket by a combination of muscles and tendons (rotator cuff). The rotator cuff covers the head of the upper arm bone and attaches it to the shoulder blade.

The muscle in the front of the upper arm (biceps) helps keep the shoulder stable and allows movement such as bending an elbow and rotating an arm. The biceps muscle is attached to bones in the shoulder by two tendons. The long head of the biceps tendon (upper biceps tendon) is a strong, cord-like structure that connects the upper end of the biceps muscle to the top of the shoulder socket. The short head of the biceps tendon attaches to a bump on the shoulder blade (coracoid process).

Description

Inflammation is the body's natural response to injury, disease, overuse or degeneration, and it often causes swelling, pain or irritation. Inflammation of a tendon is called tendinitis. An inflammation or irritation of the upper biceps tendon is called long head of biceps tendinitis.

Symptoms

Common symptoms of upper biceps tendinitis include:

• Pain or tenderness in the front of the shoulder, which worsens with overhead lifting or activity.
• Pain or achiness that moves down the upper arm bone.
• An occasional snapping sound or sensation in the shoulder.

Nonsurgical Treatment

• Rest—The first step toward recovery is to avoid any activity that requires you to raise your arm over your head.
• Ice—Keep swelling down by applying a cold pack to the affected area for 20 minutes, several times a day. Do not apply ice directly to the skin.
• Nonsteroidal anti-inflammatory medication (NSAIDS)—Drugs such as ibuprofen or naproxen may help relieve pain, inflammation and swelling. Most people are familiar with nonprescription NSAIDS such as aspirin and ibuprofen, however, whether using over-the-counter or prescription strength, they must be used carefully. Using these medications for more than one month should be reviewed with your primary care physician. If you develop acid reflux or stomach pains while taking an anti-inflammatory, be sure to talk to your doctor.
• Steroid injections—Steroids, such as cortisone, are very effective anti-inflammatory medicines and injecting them into the tendon can relieve pain. Your doctor will use these cautiously.
• Physical therapy—Specific exercises or a shoulder conditioning program will help restore range of motion and strengthen your shoulder.

Surgery

Surgery for biceps tendinitis is usually performed arthroscopically. During this minimally invasive procedure, your orthopaedic surgeon will make very small incisions around your shoulder.

• Repair—In many cases, the biceps tendon can be repaired and strengthened where it attaches to the shoulder socket (glenoid).
• Biceps tenodesis—During this procedure, the damaged section of the biceps is removed and the remaining tendon is reattached to the upper arm bone (humerus). Removing the painful part of the biceps usually resolves symptoms and restores normal function. Your orthopaedic surgeon may choose to do this procedure arthroscopically, or through an open incision, depending on your individual situation.
• Tenotomy—Your orthopaedic surgeon may simply elect to release the damaged biceps tendon from its attachment. Although this is the least invasive option, it may result in a "Popeye" bulge in the arm. Younger people may notice weakness with flexion after this surgical procedure.

With any surgery there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. Your orthopaedic surgeon will speak to you prior to surgery to explain any potential risks and complications that may be associated with your procedure.