Bicep Tendonitis is an injury that is common among athletes who perform an overhead throwing or pulling motion found in football, baseball, weightlifting, gymnastics, and swimming, among others.
The bicep muscles, located at the font of the upper arm, are crucial for movements that involve raising the arm or bending it at the elbow.
The bicep tendons (biceps brachii) include two that attach the muscle to the shoulder bones, and one that attaches the muscle to the radius bone at the elbow.
If these tendons become irritated or injured, they can develop micro-tears or ruptures (full tears) that lead to pain and inflammation, ultimately requiring bicep tendonitis treatment.
Understanding the symptoms, causes, and available treatment options for biceps tendonitis can be important for anyone struggling with the pain of a bicep injury.
What is Bicep Tendonitis?
In the body, tendons connect muscles to bones and provide flexibility and mobility during movement. With excessive friction, overuse, injury, or repetitive movements, these tendons can become inflamed and cause pain that ranges from mild to severe.
Tendonitis means there are swollen or damaged tendons in the bicep. Over time, this can develop into a condition known as tendinosis. Here, repeated friction, injury, or overuse causes a thickening or enlargement of the tendon that can lead to degeneration of the tissue and chronic pain issues.
Of the two bicep tendons in the shoulder (biceps brachii), named the long head and short head, tendonitis is more common in the long head, which attaches the muscle to the top of the shoulder joint.
Bicep tendinitis is also common at the elbow, though generally most people do not develop biceps tendonitis at the shoulder and elbow at the same time.
What are the Causes of Biceps Tendonitis?
Biceps Tendonitis can develop for a variety of reasons, including normal wear and tear over the course of a person’s life that leads to a bicep tendon strain or a bicep tendon tear.
Other common causes are repetitive movements or overuse injuries as a result of sports or vocational activities. This is especially true for motions that require repeated overhead movements.
Injuring the biceps tendon by falling, lifting a heavy object improperly, serious accidents, or even other issues, like a rotator cuff tear, can also cause biceps tendonitis.
Distal bicep tendon pain refers to tendinitis pain at or near the elbow. In rare cases, lifting heavy objects can result in a distal bicep tendon tear. This is a serious injury that causes the muscle to separate from the bone and retract back toward the upper arm.
While a person with a torn distal bicep tendon can still use their arm, there will be a loss of strength in motions that require palms-up rotations, like using a screwdriver or other tools.
Bicep Tendonitis Symptoms
Regardless of how a person develops biceps tendinitis, whether from the aging process, overuse on the job, sports-related training, or serious accident, it can be a painful condition that inhibits a person’s mobility and ability to perform at high levels.
The severity of biceps tendinitis symptoms can range from mild to severe and may include some of the following:
- Pain or soreness at the front of the shoulder
- Discomfort that may run down the arm and worsen at night or with activity
- A cracking or clicking noise or a snagging sensation when using the shoulder and arm
- Decrease in range of motion in the arm and shoulder
- Weakness in the arm
- Inflammation and soreness in the shoulder or arm
However, there are a number of effective treatments that can improve this condition.
Biceps Tendinitis Treatment
With overuse conditions like this, prevention is key. It’s important to pay attention to early warning signs, such as bicep tendon pain, that fades as the body warms up, or low level bicep soreness after activity.
Receiving a diagnosis requires a physical examination from a physician, along with a discussion about symptoms and recent or long-term physical activities and habits.
It is likely that a sports physician will perform an ultrasound to examine the soft-tissue, in combination with an MRI and x-rays to rule any other issues, such as a rotator-cuff tear.
Based on the severity of a person’s bicep tendonitis symptoms, injury, and inflammation, treatment options can include some of the following:
1. Rest the Injury
Combining rest and avoiding activities that cause pain may allow bicep tendonitis to dissipate on its own. Obviously, taking time off from work or sports is easier said than done because the bicep is a key muscle in many of our common movements.
2. Ice or Cold Compress
In the early stages of tendonitis, applying ice or a cold compress to the injury can be effective for alleviating some of the pain and swelling.
3. Pain Medications
Nonsteroidal anti-inflammatory pain medications, like ibuprofen (Advil) or naproxen (Aleve), are useful for reducing pain and inflammation.
4. Cortisone Injections
Injections of cortisone, a powerful steroidal anti-inflammatory, may be recommended in some cases. While this slightly invasive and somewhat painful procedure will reduce swelling and pain, it can also weaken surrounding healthy soft-tissue and lead to an increased risk of other tendon injuries.
5. Shockwave Therapy
Extracorporeal Shock Wave Therapy (ESWT), also known as EPAT, or simply Shockwave Therapy, is a noninvasive, painless procedure that promotes faster healing by increasing blood flow with new blood vessel growth and creates proteins that promote tendon repair.
A Shockwave machine delivers low or high-pressure impulse waves deep into the soft-tissue of the biceps tendon delivered over a number of short sessions.
Shockwave Therapy can be done while a person is still active, even in combination with physical therapy, because there is no anesthesia required. It is also beneficial for reducing injury-related downtime.
6. Physical Therapy
Physical Therapy is sometimes recommended so people can learn proper movement techniques as well biceps tendonitis exercises to help build strength and flexibility as the shoulder or elbow recovers.
The length of time it takes to heal will vary based on the seriousness of a person’s condition, and at least several physical therapy sessions will be required over a few weeks.
7. Bicep Tendon Surgery
Bicep tendon surgery may be necessary for some people, especially in the case of a distal bicep tendon tear. However, this is generally a last resort treatment method reserved for when all other, less invasive, approaches have failed.
Surgeons may attempt to remove or trim damaged tissue and then reattach it to the bone. This surgery can have good results, but there are always risks with surgery that should be discussed ahead of time. It will probably require a significant amount of healing and rehab downtime before a full recovery is achieved.
The pain and symptoms of a bicep tendonitis injury caused by overuse or repetitive movements can limit mobility for athletes and people who are required to do a lot of heavy lifting at work.
Resting the bicep tendon strain and limiting strenuous activities are recommended at the earliest signs of a possible injury. If pain persists, see a doctor to rule out any other types of issues.
The treatment options shown above can be effective for reducing pain and inflammation, while helping to heal the bicep tendon to resume normal activities more quickly and prevent further injury.
Biceps image courtesy of CFCF.