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Biceps Tendonitis


The biceps muscle is in the upper arm and has multiple functions including bending and rotating the elbow and keeping the shoulder stable. There are two shoulder attachments of the biceps, one at the coracoid and one at the glenoid. Injury most commonly occurs to the head that attaches at the glenoid (long head). It is found most easily in its groove below the pectoralis muscle as it attaches to the upper arm (humerus). Long head of biceps tendonitis is an inflammation or irritation of the long head of the biceps tendon.

Symptoms

Injuries to the biceps tendon at the shoulder usually occur from chronic wear Symptoms of a biceps tendonitis include pain and weakness or snapping in the front of the shoulder. This can result from repetitive use, degeneration, or injury.

Evaluation & Treatment

Evaluation begins with a history of the injury, physical examination including special maneuvers, and X-rays to rule out other injuries. An MRI is helpful to distinguish the extent of tendonitis or other causes of pain.

Initial treatment is with rest, ice, anti-inflammatory medications and physical therapy. A corticosteroid injection may reduce pain as well as confirm the diagnosis. Surgical treatment is considered for those that do not improve. Surgical treatment may be done as an arthroscopic or mini-open surgery. There are a variety of surgical options including repair, tenodesis, or tenotomy. Repair can be done in conjunction with a SLAP repair. Tenodesis, or anchoring of the biceps, is done in those who perform repetitive activities or for those with cosmetic concerns and involves the removal of the damaged section and reattachment of the biceps tendon to a different location. Tenotomy is considered in those who want the most minimally invasive surgery or are low demand. It involves releasing the long head of the biceps from its origin on the glenoid (socket).

Rehabilitation is dependent on the technique utilized. Repair and tenodesis requires a sling and gentle passive range of motion for 4-6 weeks. Tenotomy allows for immediate range of motion.