Tendinitis is the inflammation, irritation or swelling of a tendon. A tendon is an extension of the muscle that attaches to the bone. The biceps muscle runs down the front of the arm from the shoulder to the elbow, and it’s primary function is to flex (bend) the elbow and supinate the forearm (rotate the hand to palm-up position).
Biceps tendinitis, most commonly, is an overuse injury. As an overload is placed on the tendon, it leads to microscopic tears, which in turn cause inflammation. The demand that is placed on the muscle and tendon with overhead throwing makes baseball and tennis players especially at risk. But anyone who frequently overloads the biceps—moms carrying an infant in one arm, yard work/pruning, carpenters, drywallers—is at risk of developing biceps tendinitis.
The primary symptom of bicipital tendinitis is pain in the anterior shoulder and often down the front of the arm to the elbow. The first sign is usually pain in the shoulder after activity. As the condition progresses, there may be pain at the beginning of the workout, or activity, which may resolve as you warm up, only to return again after your done. At this stage, your activity and strength is not yet restricted. As you continue to overstress the area, causing more microtearing and resulting inflammation, you may find you have pain now during your entire activity or workout, and persists into the night. You may now find this pain restricts your activity. As this condition continues to progress, there may be pain with everyday activities.
Localized tenderness is usually present right over the tendon as it runs through the bicipital groove (in the front part of the shoulder).
Resisted muscle testing of the biceps muscle will often be painful. There is specific muscle and joint testing that can be done by a physician or physical therapist that can help to differentiate between bicipital tendinitis and other conditions that also cause shoulder pain. Rotator cuff injury, labral tears, impingement syndrome and cervical spine disease, are a few conditions that can cause shoulder pain as well. X-ray, MRI, and EMG studies may help to rule out some of these conditions.
In the early stages of tendinitis, rest and ice may be enough to resolve the injury. But if the injury persists or worsens, a visit to your doctor or physical therapist is strongly recommended.
Your physician may prescribe anti-inflammatory medication or steroid injection to help ease pain and decrease inflammation in order to allow physical therapy to begin.
Physical therapy will help to stretch and strengthen the biceps muscle and tendon, reduce scar tissue, promote healing, and address the surrounding areas as well. For example, there may be weakness in the muscles that stabilize the scapula (shoulder blade), or rotator cuff muscles. Weakness in these muscles cause the biceps to work harder, trying to compensate for the other muscles.
Strengthening exercises should initially emphasize high repetition and low load. Studies have shown that this type of exercise increases the structural strength of the muscle/tendon, making it more resistant to injury. It also promotes healing by stimulating increased blood flow and neuromuscular activation. As the muscle/tendon get stronger, exercises are progressed to higher resistance and lower reps. The goal of strengthening should be to achieve a higher level of strength than before the injury.
Massage can help to break up adhesions and scar tissue that has formed along the tendon sheath. Inflammation, especially when repetitive, tends to cause the formation of scar tissue. Scar tissue, especially if it builds up too much, can interfere with the function of the muscle/tendon, and weaken the structure of the muscle/tendon, leading to chronic re-injury.
Normal range of motion should be restored and maintained via a combination of dynamic and static stretching. Besides the biceps, it is common for the pectoralis minor/major, latissimus dorsi and other muscles to need increased flexibility.
Modifying the activity that is causing the injury is also an important step. Sport or activity specific exercises should be performed. A physical therapist can help to teach proper mechanics and exercise technique in order to prevent this injury from happening again.
Remember, ignoring or trying to work through shoulder pain often leads to a more serious injury. Most overuse injuries can be easily and successfully treated without much “down time” or surgery IF proper action is taken in a timely manner.
Visit our Shoulder/Throwing Physical Therapy page to learn about the specialized rehabilitation program COAST Rehab offers.