Biceps Pain

Bicipital tendonitis is the inflammation of the biceps tendon, the tissue that connects muscle to bone in your upper arm, causing pain in the upper arm and shoulder. It is more common in men in the age group of 40 to 60 years and occurs during many sports activities like tennis, baseball, weightlifting and kayaking where overhead movement is involved.

Anatomy

Two separate tendons or heads in the upper arm, the long head and short head, converge to form a single muscle called the biceps muscle. The long head passes through the shoulder joint and into the bicipital groove, which is a depression in the arm bone. When the tendon get inflamed due to stress or injury, as seen in bicipital tendinitis, it rubs against the joint or groove, causing pain.

Causes

The common causes of bicipital tendonitis include overuse of the arm and shoulder especially in sports, inflammatory diseases like bursitis or arthritis, injury or infection.

Symptoms

Bicipital tendinitis is characterised by pain in the shoulder, which may travel to the forearm, tenderness at the region where the biceps contacts the shoulder, reduced shoulder movement, and a bulge in the biceps if a tendon ruptures.

Diagnosis

On presenting with shoulder pain, your doctor will conduct a thorough examination of your shoulder to identify the site of inflammation and the movements that cause pain. X-rays and MRI scan may be suggested to confirm on the diagnosis.

Treatment

First line treatment options include rest, ice, compression and elevation (RICE) and

nonsteroidal anti-inflammatory drugs (NSAIDs) to bring down the inflammation and pain. Your arm may be placed in a sling for comfort. Alternatively, an anaesthetic and steroid can be injected in your shoulder.

If conservative treatment does not give relief, surgery is performed. Through surgery, the inflamed tissue can be removed (biceps debridement), the long head of the tendon can be cut so that it does not rub against the joint and groove (biceps tenotomy), or the tendon can be cut and reattached lower down the arm (biceps tenodesis).

Prevention

Bicipital tendonitis can be prevented by modifying overhead hand activities with guidance from a physiotherapist.