What is tendinopathy?
The inflammation of tendon of the long head of the biceps muscle causes biceps tendinopathy. Biceps mainly functions for elbow flexion and supination, hence tendinopathy may hamper a lot of daily activities.
The early stages of tenosynovitis occur secondary to repetitive friction, and shoulder rotation.
The tendon increases in diameter secondary to swelling and it predisposes the tendon to pathologic shear forces.
As the pathophysiology progresses, there is thickening, fibrosis, and vascular compromise.
In advanced conditions, the tendon can eventually rupture.
- Atraumatic onset of anterior shoulder pain
- Pain with overhead activities
- Pain at rest and at night
- History of overhead sports
- Present or History of physical laborer occupations
Assessment findings of biceps tendinopathy-
- Pain with palpation over the bicipital groove
- Restricted range of motion
- Muscle weakness
- Accompanying involvement of shoulder
Conservative: managed with pain relieving medications such as NSAIDs or steroid injections if necessary.
Surgical: If conservative management has not been successful then surgical management can be considered. This is indicated usually in athlete population.
Physical Therapy and its role-
- Training of isometrics if pain is the primary issue progressing into eccentric training and eventually concentric.
- Use of modalities, including ultrasound, iontophoresis, etc
- Stretching and strengthening exercises
Clinical Bottom Line
Biceps tendinopathy is an inflammatory process. Thus it can be caused ageing as well by a degenerative process. The degenerative changes usually occurs in athletes with repetitive overhead movements.
- The patient will primarily experience pain localised in the bicipital groove.
- The pain may radiate toward the insertion of the deltoid muscle, or down to the hand.
- Treatment consists of conservative or surgical treatment. Surgery should be considered if conservative measures fail after three months and for those populations who have a high functional demand.