Biceps Tendinopathy - Symptoms, Diagnosis, Management, and Prevention

What Is Biceps Tendinopathy?

The biceps muscle is present in the front side of the upper arm and helps in reaching up above the head, lifting up, and bending the elbow. Around the long head of the biceps muscle, there is a tendon, and biceps tendinopathy occurs when this biceps tendon is repetitively stretched and overused. It occurs in individuals who play sports that require frequent reaching up and lifting up. Biceps tendinopathy does not refer to one single condition in the tendon. It involves the following:

1. Biceps Tendinosis: This condition occurs when the tendon around the biceps is inflamed. This is a state of chronicity, and inflammation is present.

2. Biceps Tendonitis: It is a condition in which the tendon around the biceps is injured and undergoing degeneration without inflammation. There is inflammation, and this is acute.

3. Biceps Tenosynovitis: This condition occurs when the tendon sheath around the biceps is inflamed and is characterized by degeneration and disruption of the tendon fibers.

4. Ruptured Biceps Tendon: Rupture occurs after the injury or inflammation of the biceps tendon.

How Does It Occur?

It is common in people who play sports like gymnastics, contact sports, badminton, and swimming. It can also occur in individuals who do repetitive movements to the shoulder that require overhead lifting and heavy weight lifting. It also occurs in degenerative diseases like arthritis and can be seen after trauma to the upper arm. Arthritis is a medical condition in which one or more joints are affected and cause pain and progressive stiffness with age.

What Are the Symptoms?

• Persistent dull pain at the front of the shoulder.

• Inability to perform activities like overhead reaching and lifting weights.

• Discomfort in lying on the affected side.

• Weakness of the affected shoulder.

• Swelling and redness around the affected area.

• Reduced range of motion of the affected shoulder.

• Pain aggravates while using the affected arm.

• A clicking sound when trying to raise the arm.

How Is It Diagnosed?

A thorough clinical history is taken to see activities performed by the patient at work. A series of examinations are done to diagnose tendinopathies. Ultrasound and MRI (magnetic resonance imaging) are done to clearly depict the detailed images of tendons and muscles involved.

1. Yergason’s Test: This test is done by asking the patient to stand straight and bend the elbows at right angles to the body and near the body. The therapist then locates the bicipital groove, which is an indentation in the anterior surface of the ball and socket joint of the shoulder. By pressing on this groove, the patient is asked to supinate against resistance. Supination is the rotational movement of the hand in which the pal faces forward or upward. If pain or a clicking sound is present, then the test is positive.

2. Hawkin’s Test: This test is done by the therapist by passively lifting the arms parallel to the floor. By keeping the arms straight, the patient is asked to bend the elbow at a 90-degree angle, and the presence of pain confirms the diagnosis.

3. Speed test: The patient is asked to keep the elbow extended and forearm supinated. The patient is then asked to flex or bend the shoulder against resistance. If pain is present near the bicipital groove, then the test is considered positive.

What Are the Various Treatment Options?

• The very first step in managing biceps tendinopathy is allowing the arms to rest for a while.

• Pain can be managed by NSAIDs (non-steroidal anti-inflammatory drugs) like Ibuprofen or Naproxen.

• The application of ice over the affected area for 15 to 20 minutes can minimize pain and swelling.

• Corticosteroid injections are given in the subacromial or intra-articular route to relieve symptoms.

• Arthroscopy is done in untreated cases and patients who do not recover from conventional techniques.

• Arthroscopic tenodesis or tenotomy is also done for the decompression of the injured tendon. Tenodesis involves severing and reattaching the tendon, while tenotomy involves dividing the tendon.

How to Manage Tendinopathy With Physiotherapy?

Physiotherapy aims to minimize pain and restore function in the affected joints. The following methods are used in physical therapy:

1. Soft Tissue Massage Therapy: It is done by physiotherapists with transverse gliding of the affected tendon and cross-friction massage. Cross friction massage is a type of connective tissue massage done by the therapist using hands to induce collagen formation, which helps reform the damaged tissues.

2. Electrical Stimulation: This method has also been shown to relieve symptoms effectively. It uses electrodes to apply electric current over the affected area and will help reduce pain.

3. Ultrasound Therapy: Thisis done to reduce pain and swelling and as well promote healing of the damaged tissue. Ultrasound involves the application of sonic waves in a controlled environment, and this will produce heat. This heat can numb the pain in the affected area. It also promotes the revascularization of the affected tissues.

4. Moist Heat Application: Applying moist heat during stretching activities has been effective in reducing pain.

5. Stretching and Strengthening Exercises: A wide range of exercises are done to improve the range of motion and strengthen the affected muscles.

A) Stretching Exercises:

1. Pendulum Stretch: Before performing the exercise, an application of hot packs for five minutes is recommended. Sit in a chair and allow the affected arm to be relaxed in the free air. With the hands straight, try to swing it front and back and then from side to side. After this, try to draw small circles using the affected hand in the air. These exercises should be done for five to ten minutes a day. After some days, as the symptoms reduce, the diameter of the circles can be improved for effective stretching.

2. Wall Walks: Stand near a wall and keep the affected arm on the walls with the elbow bent. Now slowly do finger-walking on the wall using the fingers above the shoulder level. Do this exercise for five minutes a day, several times a day.

3. Biceps Stretch: Stand near a wall and raise the affected hand to shoulder height, keeping it parallel to the wall with palm down and thumb near the wall. Now slowly, turn the body to the opposite side, keeping the hand still until a stretch is felt. Hold this for 15 seconds and repeat it thrice a day.

4. Biceps Curls: Stand straight with the injured arm hanging free in the air and palms facing out. Now slowly, bring the palm toward the shoulder by bending the arm at the elbow. Hold this position for 30 seconds and bring the arm back to its original position. Repeat two sets twice a day.

B) Range of Motion Exercises:

1. Shoulder Flexion: Lie flat on the back and hold a stick with both hands at a distance that is shoulder-width apart. Slowly raise both hands over the head until a stretch is felt. Hold this position for 30 seconds and repeat it two times twice a day.

2. Shoulder Abduction: Lie flat on the back and hold a stick with both hands at a distance that is shoulder-width apart with a thumbs-up position. Slowly push the affected arm away from the body as far as possible and relax to the original position. Following this, try to lift the stick as far over the head until a stretch is felt. Hold onto each position for 30 seconds and repeat two times twice a day.

3. Elbow Flexion: It is done by using a weight such as a dumbbell in hand. Stand straight with palms facing forward. Slowly lift the weight using the affected arm by bending near the elbow and holding for 30 seconds, and then return to the original position. Do this exercise two times twice per day.

4. Shoulder Internal Rotation: It is done by holding a towel at the back using both hands, grasping the two ends. Slowly stretch the affected arm up in the back as long as a stretch is felt. Hold this position for 30 seconds, and then relax. Do this exercise two times twice per day.

How to Prevent Biceps Tendinopathy?

• A proper warm-up and stretching should be done before starting any sporting activity.

• Do not overstress the shoulders and arms.

• Avoid doing repetitive actions on the shoulder for a long duration.

• Appropriate rests in between games and breaks in between work should be followed.

• Conditioning the shoulders using strengthening exercises and range of motion exercises.

Conclusion

Biceps tendinopathy can be a disabling condition if not properly managed and as soon as possible. This condition can progress and lead to rupture of the tendon, which may require surgery as a last resort. However, timely identification of this condition can significantly help the patient minimize the pain and discomfort caused due to this. Conventional physiotherapy and daily exercises that include stretching and strengthening exercises can greatly help in restoring the form and function of the affected shoulder. Never ignore any symptoms, and seek medical help at the earliest because prevention is always better than cure.