Biceps Tendinitis
Anatomy of Biceps Tendon:
The upper end of the Biceps Muscle has two Tendons that are attached to the bones in the Shoulder. The long head is attached to the top of the Shoulder Socket (glenoid). The short head is attached to a bump on the Shoulder blade called the coracoid process.
The long head of the Biceps Tendon rises from the supraglenoid tubercle and the superior glenoid labrum. The proximal portion of the long head of the Biceps Tendon is extrasynovial but intra-articular. The Tendon travels obliquely inside the Shoulder Joint, across the humeral head anteriorly, and exits the joint within the Bicipital Groove of the humeral head beneath the transverse humeral ligament. The Bicipital Groove is defined by the greater Tuberosity (lateral) and the lesser Tuberosity (medial). The Biceps Tendon is contained in the rotator interval, a triangular area between the subscapularis and supraspinatus tendons at the Shoulder. The rotator interval is responsible for keeping the biceps tendon in its correct location. As the rotator interval is usually indistinguishable from the rotator cuff and capsule, lesions of the Biceps Tendon are usually accompanied by lesions of the rotator cuff.
What is Biceps Tendinitis?
Biceps Tendinitis is inflammation of the Tendon around the long head of the Biceps Muscle. Biceps Tendinosis is caused by degeneration of the Tendon from athletics requiring overhead motion or from the normal aging process. Inflammation of the Biceps Tendon in the Bicipital Groove, which is known as Primary Biceps Tendinitis, occurs in 5% of patients with Biceps Tendinitis. Biceps Tendinitis and Tendinosis are commonly accompanied by rotator cuff tears or SLAP (Superior Labrum Anterior to Posterior) Lesions.
Symptoms:
Patients with Biceps Tendinitis or Tendinosis usually complain of a deep, throbbing ache in the anterior Shoulder. Repetitive overhead motion of the arm initiates or exacerbates the symptoms. The most common isolated clinical finding in Biceps Tendinitis is Bicipital Groove point tenderness with the arm in 10 degrees of internal rotation.
Investigations:
Local anesthetic injections into the biceps tendon sheath may be therapeutic and diagnostic. Ultrasonography is preferred for visualizing the overall Tendon, whereas magnetic resonance imaging or computed tomography and arthrography is preferred for visualizing the intra-articular Tendon and related pathology.
Treatment:
Conservative management of Biceps Tendinitis consists of rest, ice, oral analgesics, physical therapy or corticosteroid injections into the Biceps Tendon Sheath. Surgery should be considered if conservative measures fail after three months, or if there is severe damage to the Biceps Tendon.