Jessica Cheung

Bicipital Tendonitis
Pathophysiology

Bicipital tendonitis is an inflammatory process of the long head of the biceps tendon. It is a common cause of shoulder pain due to its position and
function.
The tendon is exposed on the anterior shoulder as it passes through the humeral bicipital groove. Disorders can result from impingement or as an
isolated inflammatory injury.
Other causes are secondary to compensation for rotator cuff tears, labral tears, and intra-articular pathology.

Etiology

Damage to the biceps tendon is usually due to a lifetime of overhead activities. Aging causes the tendons to slowly weaken with everyday wear and
tear. Degeration can be made worse with daily overuse activities
Swimming, tennis, and baseball are some examples of repetitive overhead activities.
Repetitive overhead motions play a part in other shoulder problems as well such as rotator cuff injuries, OA, and chronic shoulder instability.
other causes include injury, infection, inflammation

Epidemiology

Bicipital tendonitis is often diagnosed in association with rotator cuff disease as a component of the impingement syndrome or secondary to intraarticular pathology, such as labral tears.

Risk Factors

Data regarding incidence of bicep injury remains to be limited.

Swimming, tennis, and baseball are some sports examples of risk factors associated with bicipital tendonitis, along with overhead activities in
general.
Other risk factors include frequent movements, which include frequent pulling, lifting, reaching, or throwing.

Clinical Manifestation

Patients typically complain of achy anterior shoulder pain, which is exacerbated by lifting or elevated pushing or pulling. A typical complaint is
pain with overhead activities.
Tenderness is usually located over the bicipital groove, and may be localized best with the arm in ten degrees of external rotation.
Flexion of the elbow against resistance makes the pain worse

Diagnosis

Laboratory tests are not usually indicated in causes of bicipital tendonitis unless the differential diagnosis is systemic or excluding the possibility of
neoplasms.
Standard shoulder radiographs are generally not helpful or necessary in cases of isolated bicipital tendinitis.
MRI can demonstrate the entire course of the long head of the biceps tendon and should be considered after unsuccessful rehabilitation and in cases
of suspected rotator cuff injury or labral tear injury
Although ultrasound has the most variable results, newer technologies have resulted in improved visualization of the calcific deposits, edema, and
tendon displacement that are often associated with bicipital tendinitis

Treatment

the initial goals of physical therapy for acute bicipital tendonitis are to reduce swelling and inflammation. Pts should restrict over the shoulder
movements, reaching, and lifting.
Patients should apply ice to the affected area and take NSAIDs for symptomatic relief. The degree of immobilization depends on the degree of
injury and the patients discomfort level.
A local injection of anesthetic and steroid can be administered in the bicipital groove. It is typically recommended three to six weeks after acute
injury. A repeat injection can be administered four weeks later.

Prognosis

Prognosis is dependent on the degree of injury, but most patients do well with physical therapy, surgical intervention, or steroid/anesthetic
injections.
Unfortunately, a significant number of individuals develop degenerative changes and spontaneous rupture of the biceps tendon, which occurs in ten
percent of patients.

Patient Education

patients should be educated on the increased risk of biceps tendon rupture or chronic inflammatory changes exist if the directed restrictions are not
followed.
Patients should not return to activity until the patients discomfort and pain is effectively controlled.

It is recommended that patients do not return to activity until three weeks after the pain has completely resolved.

Britt A Durham, MD; Chief Editor: Sherwin SW Ho, MD. Bicipital Tendonitis. http://emedicine.medscape.com/article/96521-overview#a0106 (accessed 4 May 2014).