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Biceps Tendinitis

(Also known as Bicep Tendonitis, Biceps Tendinopathy, Biceps Tendonitis)
Note - Although research suggests that 'biceps tendinopathy' is the more appropriate term to describe overuse injuries to the biceps tendon, we will use the term 'biceps tendinitis' in this document as it is more widely known.

What is biceps tendinitis?
Biceps tendonitis is a condition characterized by tissue damage to the biceps tendon causing pain in the front of the elbow.
The muscle at the front of the upper arm is known as the biceps. The biceps originates from the front of the shoulder blade and inserts into the forearm via the biceps tendon.
During contraction of the biceps, tension is placed through the biceps tendon. When this tension is excessive due to too much repetition or high force, damage to the biceps tendon occurs. Biceps tendinitis is a condition whereby there is damage to the biceps tendon with subsequent degeneration and inflammation. This may occur traumatically due to a high force going through the biceps tendon beyond what it can withstand or due to gradual wear and tear associated with overuse.

Causes of biceps tendinitis
Biceps tendinitis most commonly occurs due to repetitive or prolonged activities placing strain on the biceps tendon. This typically occurs due to excessive lifting, or bending of the elbow against resistance (such as performing chin ups or bicep curls). Occasionally it may occur suddenly due to a high force going through the biceps tendon beyond what it can withstand. This most commonly occurs during heavy weight lifting in a gym environment.

Signs and symptoms of biceps tendinitis
Patients with biceps tendinitis typically experience pain in the front of the elbow. In less severe cases of biceps tendinitis, patients may only experience an ache or stiffness in the elbow that increases with rest following activities requiring strong or repetitive contraction of the biceps muscle. These activities may include carrying heavy shopping bags, performing biceps curls or chin ups etc.
In more severe cases, patients may experience an ache that increases to a sharper pain with activity. Occasionally patients may notice swelling at the front of the elbow and experience weakness when attempting to lift objects.

Diagnosis of biceps tendinitis
A thorough subjective and objective examination from a doctor is usually sufficient to diagnose biceps tendonitis. Occasionally, further investigations such as an Ultrasound, X-ray or MRI scan may be required to assist with diagnosis and assess the severity.

Prognosis of biceps tendinitis
Most patients with biceps tendinitis heal well with appropriate rehabilitation therapy and return to normal function in a number of weeks. Occasionally, rehabilitation can take significantly longer and may take many months in those who have had the condition for a long period of time. Early therapy treatment is vital to hasten recovery in all patients with biceps tendinitis.

Treatment for biceps tendinitis
The success rate of treatment for biceps tendinitis is largely dictated by patient compliance. One of the key components of treatment is that the patient rests from ANY activity that increases their pain until they are symptom free. This allows the body to begin the healing process in the absence of further tissue damage to the biceps tendon. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the condition becoming chronic. Immediate, appropriate treatment is essential to ensure a speedy recovery. Once chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence.
Patients with biceps tendinitis should follow RICE in the initial phase of injury. RICE is beneficial in the first 72 hours following onset or when inflammatory signs are present (i.e. morning pain or pain with rest). RICE involves resting from aggravating activities, regular icing, the use of a compression bandage and keeping the arm elevated. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
Patients with biceps tendinitis should undergo a graduated flexibility and strengthening program of the biceps to ensure an optimal outcome. The treating therapist can advise which exercises are most appropriate for the patient and when they should be commenced.

Contributing factors to the development of biceps tendinitis
There are several factors which can predispose patients to developing biceps tendinitis. These need to be assessed and corrected with direction from a therapist. Some of these factors include:
  • joint stiffness (particularly the elbow)
  • muscle tightness (particularly the biceps)
  • inappropriate or excessive training
  • inadequate warm up
  • muscle weakness

Therapy for biceps tendinitis
Therapy treatment for patients with this condition is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • stretches
  • joint mobilization
  • ice or heat treatment
  • exercises to improve strength and flexibility
  • education
  • anti-inflammatory advice
  • activity modification advice
  • a gradual return to activity program

Other intervention for biceps tendinitis

Despite appropriate management, some patients with biceps tendonitis do not improve adequately. When this occurs the treating therapist or doctor will advise on the best course of management. This may include further investigations such as X-rays, ultrasound, MRI or CT scan, pharmaceutical intervention, corticosteroid injection or referral to appropriate medical authorities who will advise on any interventions that may be appropriate to improve the condition.