Biceps Tendinitis

The biceps muscle has two tendons that attach it to the shoulder:

• Long head of the biceps tendon: This tendon runs along the front of the upper arm bone (humerus) and connects to a structure inside the shoulder joint called the labrum. It is the most commonly affected tendon in biceps tendonitis.
• Short head of the biceps tendon: This tendon attaches to a small bony projection on the shoulder blade (scapula) called the coracoid process. It is less likely to develop tendonitis.

Biceps tendonitis occurs when the long head of the biceps tendon becomes inflamed, irritated, or partially torn due to overuse or injury.

Biceps tendonitis is primarily caused by repetitive stress or overuse of the shoulder. Some of the most common causes include:

1. Repetitive overhead movements: Activities that involve repeated lifting, throwing, or reaching overhead can put excessive strain on the biceps tendon. This is common among athletes who participate in sports such as baseball, tennis, swimming, and weightlifting.
2. Aging and degeneration: As individuals age, tendons lose their elasticity and become more susceptible to irritation and microtears. Degenerative changes can lead to chronic inflammation and weakening of the tendon.
3. Shoulder Impingement Syndrome: When there is not enough space in the shoulder joint, the biceps tendon can get pinched between bones, leading to irritation and swelling.
4. Rotator Cuff injuries: Damage to the muscles and tendons around the shoulder can put extra stress on the biceps tendon, increasing the risk of tendonitis.
5. Shoulder instability: When the shoulder joint is loose or unstable, the biceps tendon may be forced to compensate for the lack of stability, leading to overuse and inflammation.
6. Sudden trauma or injury: A direct blow to the shoulder or an acute injury from lifting a heavy object can cause irritation or even partial tearing of the biceps tendon.

Patients with biceps tendonitis often experience a range of symptoms that may develop gradually over time. The most common symptoms include:

• Pain in the front of the shoulder: A dull, aching pain is typically felt in the front of the shoulder, which may worsen with activity or movement.
• Pain that spreads down the arm: The discomfort can extend down the upper arm toward the elbow.
• Shoulder weakness: Patients may notice weakness, particularly when lifting objects or performing overhead movements.
• Tenderness and swelling: The front of the shoulder may feel tender to the touch, and some swelling may be present.
• Clicking or popping sensation:  Some individuals report a snapping or clicking sensation when moving the shoulder, which may indicate biceps tendon instability.
• Pain at night: Many patients experience increased pain at night, particularly when lying on the affected shoulder.

Left untreated biceps tendonitis can progress to partial or complete tendon tears, significantly impacting shoulder function and requiring more extensive treatment.

Dr. David Gazzaniga performs a thorough evaluation to diagnose biceps tendonitis. The process includes:

Medical history and physical examination

Dr. Gazzaniga will ask about the patient’s symptoms, activity level, and history of shoulder injuries. A physical exam will be conducted to assess pain, range of motion, and tenderness along the biceps tendon. Special tests may be performed to evaluate biceps tendon involvement.

Imaging studies

• X-rays: While X-rays do not show soft tissues like tendons, they can help identify bone abnormalities, such as arthritis or bone spurs, that may contribute to biceps tendonitis.
• Ultrasound: This imaging modality provides a dynamic view of the biceps tendon, allowing the physician to assess for inflammation, tendon thickening, or partial tears.
• MRI: An MRI provides detailed images of soft tissue structures, including the biceps tendon, rotator cuff, and labrum. It is useful for detecting associated injuries, such as rotator cuff tears or labral damage.