What is biceps tendonitis?
The long head of biceps follows a tortuous route from the biceps anchor in glenoid labrum through the glenohumeral (shoulder joint) and down a groove (bicipital groove) before becoming the biceps muscle. The tendon can be inflamed or damaged (degenerate) anywhere along its course causing pain in the front of the shoulder. It is often associated with rotator cuff pathology including tears and impingement.
What causes biceps tendonitis?
It can occur with repetitive loads such as heavy lifting, following a fall or simply with age. It can occur with bone spurs within the bicipital groove which pinch the tendon.
What are the symptoms of biceps tendonitis?
Typically patients present with pain in the front of the shoulder, occasionally a feeling of catching and sometimes pain when bending the elbow (flexing) with the palm facing up (forearm supinated).
How is biceps tenonitis diagnosed?
This is based on a history, physical examination and a dynamic ultrasound scan. An MRI scan may be useful in excluding other injuries.
How is biceps tenonitis treated?
Initially analgesia, rest and physiotherapy. Avoiding lifting coupled with physiotherapy aimed at optimising shoulder movements and placing less strain on the biceps tendon are associated with good outcomes.
Surgery is indicated for persisting symptoms and failed conservative treatment. It may also be performed in conjunction with a rotator cuff repair if present. Surgery may involve either cutting the inflamed or degenerate/party torn tendon (tenotomy) or cutting it and reattaching it to a different location (tenodesis). Both have fairly similar outcomes and can be performed either arthroscopically (keyhole) or through small incisions (mini-open).
Following surgery, a rehabilitation program with physiotherapy is commenced to help you return to your normal day to day activities. The progress of this is dictated by patients meeting milestones and is run under the supervision of the surgeon and specially trained physiotherapist.