Biceps Tendonitis & Biceps Tears
The biceps muscle is located in the front of the upper arm and is used when lifting, bending the arm and reaching over the head. The upper part of this muscle attaches to the shoulder with two tendons, which are tough bands of tissue that connect muscles to bones. When an upper biceps tendon becomes inflamed, the condition is called biceps tendonitis, which is also referred to as biceps tendinopathy or biceps tendinosis. Biceps tendonitis is considered a fairly common cause of shoulder pain. Biceps tendon tears can happen at the shoulder or elbow and can be partial or complete tears.
What Causes Biceps Tendonitis?
The biceps muscle is made up of two parts: the short head and the long head. The long head of the biceps is the outer portion of the muscle and connects to the top of the shoulder socket, and it is responsible for keeping the shoulder joint stable. Between the two parts, the longer head is much more likely to be affected by biceps tendonitis because it's more vulnerable due to its location.
Biceps tendonitis usually develops when this tendon endures too much strain that causes it to become irritated and inflamed. In most cases, this is the result of regularly participating in activities that require repeated overhead movements for an extended period of time. Sports like swimming, tennis and baseball, as well as painting and other jobs in which lots of shoulder motion is needed are a few examples of activities that can increase the chances of developing biceps tendonitis. Other risk factors are:
- Older age
- Weakness in the muscles of the shoulder or upper back
- Rapid/sudden changes in an exercise routine
What Causes Biceps Tears?
It is also possible to tear the biceps tendon, which usually occurs either from overuse or a specific injury. If overuse is the cause, the same forces at work in biceps tendonitis-regularly participating in too many overhead activities-can cause the tendon to wear away and eventually tear. Injuries from twisting the elbow or shoulder in an awkward way, or falling on an outstretched arm can also lead to a biceps tear.
What are the Symptoms?
The main symptoms of biceps tendonitis are pain in front of the shoulder and tenderness to the touch. In addition:
- The pain generally gets worse when performing any overhead or lifting activities
- In some patients, pain will radiate down the elbow or towards the neck
- An occasional "snapping" sound may also be heard when moving the shoulder, or a "catching" or "clicking" sensation may be felt
- As a result of pain and other symptoms, there may also be muscle weakness around the shoulder joint when reaching overhead or lifting/carrying objects
If the biceps has been torn, in addition to the above symptoms, patients may also experience:
- A sudden, sharp pain in the upper arm immediately after the injury
- You may also hear a "pop" or "snap"
- Some patients notice bruising from the middle of the upper arm down to the elbow
What is the Treatment?
If you start experiencing symptoms of biceps tendonitis that prevent you from engaging in physical activities normally, or if you believe you've torn your biceps tendon, you should see a doctor or physical therapist right away. He or she will perform a complete evaluation, which includes your medical history, a physical examination and a series of assessments for strength, flexibility and sensation. Additional tests like x-rays and MRIs are not typically needed for the diagnosis, but they may be used for some patients. Since biceps tendonitis often occurs along with other shoulder problems, these tests will determine if any other issues are present.
Biceps tendonitis and partial biceps tears in the majority of patients will improve after following a course of conservative (non-surgical) course of action. Some general home remedies that can be used are:
Rest: avoid overhead activities and any other movements requiring the use of the shoulder that can make the pain worse
Ice: apply ice or a cold compress to the shoulder 3-4 times a day to keep the swelling down; the HyperIce Shoulder Wrap allows you to ice your shoulder while still functioning normally or use the Aircast Shoulder Cryo Cuff for controlled cold therapy.
You may also need physical therapy to help with the recovery process, especially if you're still dealing with pain after following some home remedies. Your physical therapy program will be designed based on how serious your condition is, if any other issues are present, and what your goals are for recovery. Most programs will feature some of the following components:
- Strengthening exercises: these exercises will build back up strength of the biceps and specific parts of the shoulder to improve the stability of that area
- Education and functional training: your therapist will explain what activities and postures are likely to make your condition worse, and will instruct you on how to make adjustments in your life to reduce strain on the shoulder area
- Sport-specific training: if you're an athlete, your therapist will address impairments or difficulties you might have when returning to your sport, and will help guide your return with specific training protocols
- Stretching exercises: exercises like the pendulum stretch-in which the patient swings their painful arm in small circles¬-are designed to increase the flexibility of the shoulder, neck and upper back
- Manual therapy: your therapist may also use these hands-on techniques to gently move and mobilize the shoulder joint and surrounding muscles to improve flexibility and strength
- Braces: in some cases, a shoulder brace will also be needed if tendonitis or tears is at the shoulder; the Saunders DonJoy Sully Shoulder Brace and DonJoy Shoulder Stabilizer are both bracing options. For biceps tendonitis, tears or strains at the elbow, a an elbow brace like the Bionic Elbow can provide support whereas the Trizone Elbow can help provide compression
If your symptoms are severe or don't improve with the above treatments, your doctor may recommend an injection. The steroid cortisone is often used in these situations, and it will be injected directly into the tendon to provide temporary relief of pain.
It's rare that surgery will be needed for a biceps tendon injury, even if it has been torn. Your doctor may recommend surgery, though, if there is still severe pain after conservative treatments or if you are a young athlete looking to regain full strength of your arm back. For a biceps tendon tear, the surgical procedure reattaches the long head of the tendon and is usually very successful. Several months of rehabilitation will be needed afterwards.
Can Biceps Tendonitis or Tears Be Prevented?
Although there is no way to completely avoid a biceps tendon injury, there are some general changes you can make that will reduce your chances:
- Avoid overworking the shoulder with too many overhead activities that can cause pain; if you're an athlete in a sport with overhead motions, be sure to rest the shoulder on a regular basis
- Try to maintain proper posture-especially of the shoulders, neck and back-at all times
- Warm up and stretch the shoulders before engaging in any physical activity, especially if it requires overhead motions
- Perform exercises to strengthen the muscles in and around your shoulders
- Avoid lifting or carrying heavy objects held away from the body; try to keep them as close to your body instead