Bicep tendinopathy as a term encompasses both tendinitis and tendinosis. The difference between the two is what is the amount of inflammation and the time frame of the condition. The bicep itself consists of two muscular heads near the shoulder. One being the short head that does connect up to the shoulder. The short head is rarely an issue in biceps tendinopathy. The long head bicep tendon sits in a groove on the front of the humerus, called the intertubercular groove. The tendon is held in place by a ligament called the transverse humeral ligament. This can be loose from previous injury which then can allow for subluxation of the tendon from that groove. As the shoulder can pop and click at times there are other conditions that could be at play. Other conditions that could be the problem are called differential diagnosis, meaning the broad problem is shoulder pain, but within that we can have several different specific conditions that could be listed here. The reason for such an assessment at the start is to narrow down what conditions or issues we have. This helps us dial in treatment and rehab to be as effective and time consuming as possible.
Injury to the long head of the bicep can occur via trauma such as falls and direct heavy impact. More commonly it is injured from overhead actions such as throwing, swimming, gymnastics, martial arts, etc. Other causes can be from overuse or degeneration.
Biceps Tendinopathies affect 15-35 year olds more commonly. Generally seen with overhead throwing athletes, so swimming, baseball, weight lifting volleyball and other sports not named. The long head of the bicep attaches to the top part of the shoulders labrum. Because of the position and interplay of the biceps with surrounding tissue biceps tendinopathies are generally not seen in isolation, meaning there are other issues like labral lesions, rotator cuff strains, impingements, bursitis.
What an assessment CAN look like or include.
Assessing a shoulder problem is like having a target that is larger than normal. As we begin to ask questions or perform tests on the shoulder we see the target becoming smaller and smaller. As we remove conditions off the list of possibles we begin to become more targeted and find tests with repeatable results.
An assessment involves a mix of visual appearance for bruising/swelling/inflammation, passive range of motion, active range of motion, baseline movements for sport/occupation, a slew of orthopedic tests along with end range loading of the joint in question along with possible spinal components as well. We utilize both movement pattern assessments of macro movements as well as micro patterns. We are looking for the best ways to interject treatment and build a plan around the condition. The goal is to get you moving better and feeling better quickly.
Options: You have several options for musculoskeletal conditions for treatment. Many start with rest, ice, compression, elevation. Very few people truly find full resolution from that. There are options of exercise only, massage only. Sports med practices may opt for corticosteroids to drop inflammation and pain, which can be a great starting point for many people. Other options include cupping therapy, trigger point dry needling, acupuncture, heat or ice, bracing, taping and so on.
What many may not realize is the risk of doing nothing about an issue like this. Here is what you may be at risk of from doing nothing,
Treatment: Best treatment options for biceps tendinopathy involve soft tissue manipulation at the beginning. Musculoskeletal issues will present with a lack of comfortable range of motion in general shoulder movements. Surrounding tissue will present inflamed, possibly red or swollen depending on the severity and acuteness of it. Our first priority is to decrease inflammation using a variety of options. Most would think to use the R.I.C.E. method, meaning Rest, Ice, Compression, Elevation. Our options in the office vary from that. Dr. Bird uses Instrument Assisted Soft Tissue Mobilization and Electric Stimulation with intramuscular needling to help decrease inflammation and begin allowing for better pain free ranges. From there much of the treatment can involve myofascial release and/or ischemic compression of involved muscles. Adding some form of kinesiology tape for support has been shown beneficial in certain cases.
Each case is different and will present with different rates of healing and resolution. For acute conditions we see that improvement in pain can happen within a few days. If symptoms are chronic in nature we know that the tissue can be more of a degenerative nature. With that there is a possibility that symptoms can get worse before they get better.
As said previously pain amounts may change, which is great. We don’t want people to be in pain. We do however realize that there is the unfortunate opportunity for relapse or re-injury. As part of any great treatment plan for muscle or joint injuries it is vital to teach better movement patterns, adding load to the tissue to help it be resilient. With each condition having their own characteristics, load management or strength capacity is vastly more important than just being pain free. This is true especially after injury. We provide an environment that allows for physical training and building of that capacity for muscle and joint health and working towards a part of the bigger picture towards injury prevention.
Churgay CA. Diagnosis and treatment of biceps tendinitis and tendinosis. Am Fam Physician. 2009 Sep 1;80(5):470-6. PMID: 19725488.