The biceps consists of 2 heads (hence the name biceps), the short head and the long head. Biceps tendinitis refers to inflammation of the long head of biceps as it passes into the shoulder joint and attaches onto the top of the shoulder socket (glenoid).
What are the causes?
Biceps tendinitis can sometimes occur due to an injury. However, it is much more common to occur in association with other shoulder problems such as subacromial impingement or rotator cuff tear.
The long head of biceps tendon can become irritated or inflamed and fluid can surround it causing it to swell. It can also become frayed due to repetitive trauma and even snap (rupture). The tendon has many nerve endings, which causes pain down the front of the shoulder. Interesetingly, if the tendon ruptures the pain usually improves.
What are the symptoms?
Patients complain of pain over the front of the shoulder, which may go down into the biceps muscle itself. “Innocent” activities such as lifting a coffee cup, holding a kettle or turning a key can cause a sudden, sharp pain that shoots into the shoulder. Pain can also occur at night or when trying to lift heavy objects.
How is it diagnosed?
Your surgeon can usually make the diagnosis by asking about the symptoms you have and examining your shoulder.
An ultrasound or MRI is useful to confirm the diagnosis and assess for other problems such as rotator cuff tears.
How is it treated?
The quality of shoulder movement can cause irritation to the biceps and many patients will find they have started some “bad habits” with how they move their shoulder. Physiotherapy can help to improve shoulder movement and strengthen the muscles, which consequently relieves the strain on the biceps. An injection, usually performed under ultrasound guidance, can help, both to confirm the diagnosis and ease the inflammation.
Surgery is considered if symptoms persist despite physiotherapy. Surgery is directed at treating not only the biceps tendinitis but also the associated shoulder problems if present. The biceps tendinitis is usually treated with a biceps tenotomy, where the long head of biceps is cut at its origin, or a biceps tenodesis, in which the biceps tendon is cut at its origin and is reattached outside the shoulder joint. Both operations have very good results with the simpler and more preferable operation being the biceps tenotomy due to a much faster recovery.