Shoulder

Bicep Tendonitis: Shoulder Pain and Treatment

By August 22, 2019 September 16th, 2019 No Comments

The soft tissues in our bodies allow us to have a full range of motion. The term “soft tissue” encompasses most of the muscle, tendon, and cartilage in our bodies – the tissues which are not bone.

The interaction between bone and soft tissue help to facilitate our range of motion but this interaction is fragile as our soft tissues can become damaged or injured over time. Specifically, tendons are responsible for this interaction as they attach muscle to bone thereby enabling motion.

With overuse or repetitive use, they can wear down and upset the delicate nature of the relationship between bone and muscle. When tendons break down, pain in the form of Tendonitis (sometimes spelled as Tendinitis) occurs. The causes of this pain may vary from patient to patient but generally, the treatment is similar.

The symptoms of tendonitis can be spotted easily but must be treated quickly depending on the severity of the injury. Once diagnosed, there are several treatment options available to patients that are worth considering.

Tendons of the Bicep

Tendons are the tissue that connects muscle to bone throughout the body. They appear all over the body and play an active role in most of our movements. Their main function is to allow the muscles to have an anchor to the bone. This anchor creates a tether which converts the contractions in the muscles to movement by tightening and elongating the tendons which connect to neighboring bone structures. Tendons are not to be confused with ligaments; whose purpose is to connect bone to bone rather than muscle to bone.

In the bicep muscle there are two tendons which connect to the bone and are largely responsible for most of the movement of the shoulder, – the long head and the short head. The short head tendon reaches up from the bicep at an angle and attaches it to the front of the shoulder blade. The long head tendon wraps around the outside edge of the upper arm and attaches to a point in the shoulder directly behind the end of the short head tendon. Tendonitis usually occurs in the long head tendon where it wraps around the edge of the shoulder but may happen at any point in either tendon due to injury, over extension, or tearing. It is not uncommon for a patient suffering from bicep tendonitis to feel pain in either the shoulder, upper arm, or the elbow area. Depending on the career or daily activity level, this can cause a great disturbance to their way of life.

What is Bicep Tendonitis?

As the long head of the tendon detaches from the bone, a patient may feel pain in that area as well as weakness or soreness in the shoulder or elbow. Bicep tendonitis typically develops simultaneously with other issues involving the shoulder. These issues can include arthritis, complications from a dislocation, chronic pain/inflammation, issues with rotator cuff, and general degeneration. If the muscle is being used often, such as in an athlete who plays a sport that requires overhead motions, the repetition can play a role in the injury as well. Similarly to tennis elbow, the bicep tendonitis can occur when the muscle is overworked.

Signs and Symptoms

One of the first signs of bicep tendonitis is pain in the shoulder area or elbow. This pain is more likely to occur during activity, especially involving overhead motion. Sometimes a patient will experience numbness or tingling as if these areas are falling asleep due to their nerves being pinched. In some cases, the patient will experience what is called “Popeye Arm”, which is characterized by a swelling of the bicep muscle.

Diagnosing Bicep Tendonitis

The aforementioned symptoms can help a doctor pinpoint the location of an injury but in order to truly diagnose bicep tendonitis it is often necessary to use multiple diagnostic tools. Doctors can use ultrasound technology or MRIs to assess the condition of the tendon and its attachment to the bone. MRIs can also be used to determine the health of the tissue surrounding the injury and this helps influence the doctor’s treatment recommendation. MRI technologies allow doctors to locate the exact source of the pain and clearly understand its underlying cause so that it may be treated effectively.

Some doctors will also use X-Ray technology. X-Rays display the bones surrounding the bicep clearly which can help indicate a deeper structural issue which may be causing or contributing to the tendonitis. Because tendonitis occurs at the same time as other injuries or issues, X-Rays are used to ensure that the chosen treatment will alleviate all of the underlying causes of pain.

How is Bicep Tendonitis Treated?

Doctors will initially recommend non-invasive treatments for the patient such as over-the-counter anti-inflammatory medications, routing application of ice and compression, and rest. Many bicep tendonitis flare-ups can be treated with these three practices alone. The body has an amazing way of healing itself. If the patient’s lifestyle allows them to take a break to allow for healing, then they can let the tendon recover on its own.

Some patients go through physical therapy in order to strengthen the bicep and its surrounding muscles. By boosting the performance of the surrounding muscle tissues, the biceps and their associated tendons have less load befall on them, limiting the casual factors of pain. Another conventional treatment option for bicep tendonitis are cortisone steroids. These come in the form of injections and are relatively effective in managing pain levels and inflammation. Unfortunately, recent studies have shown that while cortisone is an effective pain management tool, over time these injections can further degenerate tissue and inflame the injuries which they are meant to treat.

Though conventional treatment options may be enough for minor cases of bicep tendonitis, severe cases will require more drastic treatment methods. To assess the severity of the bicep tendonitis, doctors take into account how detached the tendon is from the bone, how worn the tissues are, the degree of inflammation caused by the injury, and the amount of pain that the patient is in. When the tendon has detached completely from the bone, it is often necessary to jump to the most drastic treatment option – surgery.

Bicep tenodesis is the formal name for bicep tendonitis surgery. Doctors have several options for surgical treatment. If the tendon has detached completely or is nearing complete detachment, a screw-like medical device can be used to reattach the tendon to the bone.

In other cases, surgeons perform what is called Arthroscopy. This technique involves the use of an instrument called an arthroscope, which is simply a very small camera which surgeons use to examine the tissue surface as they perform the surgery. By using the arthroscope, surgeons can reduce the invasiveness of their procedures and help guide their surgical instruments to the correct location.

If it becomes evident that the pain is caused by more than one underlying issue, surgery is often the method used to treat pain as it can help treat the other causes of pain as well. In these instances, doctors elect for highly invasive open surgery so that they can reach various portions of the bicep at once.

Complications of Bicep Surgery

Any surgery will come with a risk of complications. Though the risk is generally small, it is necessary to be aware of what could go wrong. If tenodesis is being performed alongside other shoulder operations, which is often the case, the risk for complications increases. These operations are typically performed under anesthesia which comes with its own risks. Patients with weakened immune systems from diabetes, kidney or liver disease, or autoimmune diseases are at a greater risk of these complications. Rarely, anesthesia can come with the risk of stroke, heart attack, blood clots, pneumonia, and even death – these risks are more likely in elderly patients. Chondrolysis is also a condition often associated with arthroscopy. Chondrolysis refers to a deterioration of cartilage that can be catalyzed by forms of anesthesia.

Surgery can also come with non-anesthesia-related complications such as infection, bleeding, nerve damage, and stiffness. Nerve damage can come in several forms and can often be overcome over time with physical therapy and the body’s natural healing processes. It may become necessary for further medical intervention if nerve damage begins to interfere with daily activities. Stiffness after shoulder surgery is fairly common and almost always goes away within the first three months following surgery.

Additionally, depending on the post-operative symptoms, doctors may elect to perform a second surgery. This is called “revision surgery” and is known to have a low success rate. Revision surgeries are typically performed to relieve pain in the shoulder area post-surgery. The success of revision surgery is influenced by several factors, including number of previous surgeries, muscle strength, and tissue health. This is often viewed as a last resort, discussed only if physical therapy and conventional methods of healing are not effective after the initial operation.

Though it is sometimes deemed necessary to undergo surgery, they are not often covered by insurance which makes cost another determining factor in treatment. In addition to the high cost, recovery time can take months leaving a person unable to work or perform other daily activities. Undergoing surgery exposed the patient to health risks that may be daunting to consider, especially when the overall health of the patient is not great. Some patients have begun to consider other treatments because of these reasons.

Alternative Methods for Treating Bicep Tendonitis

In recent years, some patients have been turning to alternative methods to treat the shoulder or elbow pain caused by bicep tendonitis.

Two of the most effective alternative procedures are stem cell therapy and Platelet-Rich Plasma (PRP) therapies.

Stem Cell Injection Therapies for Bicep Tendonitis

There is a form of therapy to consider that involves stem cell injections. This form of therapy works by taking the patient’s own stem cells, which are extracted with a needle (often from bone marrow or blood and fat cells), concentrating them, and reinjecting them into the pain site. The stem cells work by essentially summoning other cells with healing properties to the site of the injury in order to help repair the damage. Doctors may use MRI technology to accurately locate the injury so that the injection of stem cells is as close to the pain site as possible. Accuracy is key here, as injecting stem cells into the wrong location will not cause injury but is a lot less likely to produce positive results. Stem cells are particularly effective in treating injuries to muscles, cartilage, and tendons. In the case of bicep tendonitis, a stem cell injection offers hope for repair without invasive surgery or lengthy physical therapy sessions.

In many cases, patients take significantly less time off of work after undergoing stem cell therapy because the recovery time is very short. Patients often feel less pain within a matter of days compared to the months it takes to recover from surgery.

Stem cell therapies are able to help patients with pain associated with bicep tendonitis when the tendon is ripped, damaged, or enflamed. Inflammation typically goes away in a matter of days and pain should be significantly reduced in only several weeks. The patient’s mobility may increase as the tendon heals but should be closely monitored by a doctor or physical therapist. It is often recommended that patients do different types of exercises similar to physical therapy in order for doctors to monitor the healing process.

PRP Therapy for Bicep Tendonitis

Platelet-Rich Plasma therapy is similar to stem cell therapy in many ways. It also involves injections, but a key difference is in what is being injected. With this type of therapy, a patient’s blood cells are extracted using a needle and put in a centrifuge. Once it has been spun around enough times, the platelets in the blood are separated from the plasma. The plasma is the benign, liquid part of blood while platelets are what hold many of the healing properties.

Doctors are able to take the platelet concentration and inject it into the pain site. MRI technology is used to find the location where the injection needs to be. Platelets contain what are called growth factors which are used to help the body heal. Once injected, the number of growth factors surrounding the injury site increases and in turn speed up the healing process.

PRP therapies have been scientifically proven to reduce pain in patients who are experiencing it in their muscles, tendons, and cartilage, similar to stem cell therapies. The patient’s range of motion may increase over time but should also be closely monitored. It is also similar to stem cell injections in that PRP is also minimally invasive, cost effective, and has a short recovery time with a high success rate.

Not Just for Tendonitis

Stem cell and PRP therapies are used to treat many different ailments, including arthritis, muscle injury, and some joint issues. This is great news because it means that patients who are suffering from bicep pain because of more than one cause may still be able to skip the surgery process. Depending on the other underlying issues in the shoulder and elbow areas, stem cell or PRP therapies can treat more than bicep tendonitis alone. Recall that these therapies are most efficient at treating muscles, cartilage, and tendons – often if there is an issue in the joint, stem cell or PRP therapies can help by being injected into the tissue between bones. They can also help with past injuries if they haven’t healed totally. It is entirely possible that receiving these injections can prevent the need for surgery altogether.

Conclusion

Bicep tendonitis is a serious issue. If the pain persists doctors work hard to determine the source of the pain using various technologies.

Depending on these results, they may recommend something more intensive such as cortisone injections or physical therapy. When faced with bicep tendonitis, it is important to check for other underlying issues that may be causing pain simultaneously.

If this is the case, surgery offers a solution to several issues with pain. It is important to consider alternative treatments to manage the pain, however, because there may be an option out there such as stem cell injections or PRP therapy that could treat pain in a much less invasive and much more cost-effective way.

It is not the end of the world to experience shoulder pain, but it can disrupt daily life. The good news is that it doesn’t have to.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni