Biceps tendinitis
Patients with biceps tendinitis, a disorder characterised by inflammation of the tendon connecting the biceps muscle to the bone, may find it difficult to carry out a variety of daily tasks. A clinical form of inflammatory tenosynovitis known as “biceps tendinitis” often affects the tendinous part of the long head of the biceps as it passes through the proximal humerus’s bicipital groove. Acute inflammatory tendinitis to degenerative tendinopathy are on the spectrum of clinical pathology. Within the younger, athletic population, a specific subgroup of individuals with primary, isolated biceps tendinitis is identified. Sports like baseball and volleyball may be somewhat provocative. Approximately 5% of proximal biceps pathology cases are caused by primary Biceps tendinitis. Primary solitary occurrences are significantly less prevalent, although they usually occur in young athletes who play baseball, softball, volleyball, gymnastics, and/or swimming. Early stages of tenosynovitis and inflammation brought on by repeated traction, friction, and shoulder rotation are the starting points of the pathophysiology of tendinitis. Early on, inflammation appears in the tendinous area of the bicipital groove. The tendon is more vulnerable to pathologic shear stresses as a result of the resulting elevated pressure and particular traction sites1.
If you are suffering from biceps tendinitis you may experience
- Exacerbation of symptoms with overhead activities
- Acute, subtle beginning of anterior shoulder discomfort
- Pain during the day and at night
- Pain from the shoulder that travels down the front arm
- There may be indications that clicking or audible popping when proximal biceps instability is present1.
Biceps tendinopathy will be assessed by the physical therapist with a comprehensive evaluation that includes a full patient history and physical examination. Physical therapist will assess the onset of symptoms, activity levels, and any specific movements or positions that provoke pain. The therapist may do specific examinations during the assessment, such as measuring shoulder range of motion, palpating the biceps tendon to check for tightness and swelling, and conducting specific tests, such as the Yergason’s or Speed’s test, to know about discomfort and muscle function2. Physical therapy for biceps tendinopathy uses a multiphase strategy to treat the condition with the goals of minimizing discomfort, regaining function, and avoiding recurrence. Usually, the first steps in treatment involve controlling inflammation and reducing discomfort using methods like cryotherapy. Then, to improve shoulder joint stability and restore muscle balance, strengthening activities are progressively added. To reduce tendon stress, isotonic workouts including bicep curls, shoulder external rotations, and scapular stabilization drills may be employed after isometric exercises. Resistance bands or small weights are frequently used for these exercises in order to gradually increase strength without exacerbating symptoms. Exercises that strengthen the scapular stabilizer are essential in the management of biceps tendinopathy. The scapular muscles—the levator scapulae, rhomboids, serratus anterior, and trapezius—are essential for preserving the stability and alignment of the shoulder. By strengthening these muscles, you can lessen the strain on the biceps tendon and other shoulder complex components by providing a stable foundation for shoulder movements3. For the better condition of the biceps, maintaining appropriate scapulohumeral rhythm is crucial, especially during the rehabilitation of disorders such as biceps tendinopathy. Scapulohumeral rhythm refers to the coordinated movement between the scapula (shoulder blade) and the humerus (upper arm) during shoulder motions. In addition to ensuring effective movement patterns and lessening the strain on the shoulder tendons, proper rhythm also improves joint stability overall4. Although biceps tendinopathy can be a difficult condition to treat, patients can effectively control their symptoms and make a full recovery with the appropriate physical therapy approach. Physical therapy tackles the underlying causes of tendon tension and promotes normal shoulder function with a combination of focused exercises, manual therapy, and education on activity adjustments.
References:
1. Varacallo M, Mair SD. Proximal Biceps Tendinitis and Tendinopathy. [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK533002/
2. Hattam P, Smeatham A. Special Tests in Musculoskeletal Examination. Edinburgh: Churchill Livingstone, 2010.
3. NSCA-National Strength & Conditioning Association. (2015). Essentials of strength training and conditioning. Human Kinetics.
4. Nho, S. J., Strauss, E. J., Lenart, B. A., Provencher, M. T., Mazzocca, A. D., Verma, N. N., & Romeo, A. A. (2010). Long head of the biceps tendinopathy: diagnosis and management. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 18(11), 645-656.
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