Biceps brachii tendinitis
Upper arm musculature, along wit rotator cuff muscles, acts as the main active stabilizers of the shoulder joint and provides functinality to the whole arm. Biceps brachii, the muscle at the anterior upper arm region connects to the top of the shoulder and the proximal part of the lower arm, to be exact, the origin of its long head is the coracoid process of the scapula, the short head originates from the supraglenoid scapular lump and the muscle descends along the humerus and connects to the proximal part of the radius bone in the lower arm. Biceps brachii performs elbow flexion, lifting of the arm and external lower arm rotation, ie. supination.
Biceps brachii tendinitis is an inflammatory state of the tendon tissue built from a series of colagen fibers. Itis caused by degenerative changes of the tendon tissue due to accumulation of microdamages over a period of time. The tendon of the biceps brachii long head, tendo caput longum m. biceps brachii, is most commonly affected and leads to pain, swelling and shoulder and arm mobility limitations especially when raising the arm above shoulder level. The most common cause for this tendon inflammation is repetitive performing of certain movements where the arm gets lifted above the shoulder, the tendon can not get sufficently rested, it gets overloaded, microdamages accumulate and lead to tendinitis and overload syndromes. This often occurs in sports that require frequent arm swinging, throwing or lifting, such as swimming, tennis, gymnastics, rowing, etc. Biceps brachii tendinitis can occur as a result of a traumatic injury, ie. after a direct fall on the shoulder or due to a prior shoulder injury or damage (shoulder impingement syndrome, shoulder instability, rotator cuff overload syndrome, etc).
This inflammation causes a feeling of pain deep in the anterior part or just below the shoulder joint and it can spread downawards to the upper arm. The intensity of the pain increases during movements, especially lifting heavy objects above shoulder level, muscle weakness can occur, and the symptoms get aleviated during rest.
Tendinitis of the biceps brachii tendons is in most cases treated conservatively, except in extreme cases when that approach does not give positive results even after a longer period, then a surgical approach is suggested. Acute therapy is aimed at reducing the pain level, inflammation and swelling by use of the RICE method (rest, ice, compression, elevation) and other physical therapy methods. Later in the functional phase of therapy shoulder mobility and flexibility should be developed, progressive strengthening of upper arm and subscapular muscles as well as exercises for stability and proper activation of different muscle groups should be implemented in the rehabilitation process. The inflammed biceps brachii tendon should be elongated through gradula flexibility and eccentric strenght exercises if it was shortened due to inflammation.
Prevention: proper warm up and stretching routines during activity, strenghtening and proper activation of muscle groups during dfferent shoulder and arm movements, etc.
Umer Butt, MD, MRCS (UK), FRCS T&O (UK), Senior Consultant Orthopaedic Surgeon
Rehabilitation program author
Dr Butt is a full time Senior Consultant Orthopaedic Surgeon Specialist in Knee/Shoulder Sports Injury, Arthroscopy and Arthroplasty Circle Bath Hospital UK AO Clinic Centre for Orthopaedic, Trauma and Sports Injury KarachiGo to profile
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