Bicep Tendonitis Diagnosis: Understanding Shoulder Pain and Treatment Options

Bicep tendonitis, an inflammation of the biceps tendon in the shoulder, is a common cause of shoulder pain that can significantly limit movement and daily activities. Accurate Bicep Tendonitis Diagnosis is crucial for effective treatment and recovery. If you’re experiencing persistent shoulder pain, especially in the front of your shoulder, understanding the diagnostic process and available treatments is the first step toward relief.

Understanding Bicep Tendonitis

What is Bicep Tendonitis?

Bicep tendonitis refers to the inflammation of the long head of the biceps tendon. This tendon attaches the biceps muscle to the shoulder blade (scapula) just above the shoulder joint, running through the bicipital groove in the humerus. The biceps tendon helps to stabilize the shoulder and is involved in shoulder and elbow movements. Overuse, repetitive motions, or injury can irritate this tendon, leading to inflammation and pain, which is diagnosed as bicep tendonitis.

Symptoms of Bicep Tendonitis

Recognizing the symptoms is a key part of bicep tendonitis diagnosis. Common symptoms include:

Pain in the front of the shoulder: This is often the most prominent symptom, which may radiate down the arm.
Tenderness to the touch: The front of the shoulder may be sensitive when pressed.
Pain that worsens with activity: Lifting, pulling, or overhead activities typically aggravate the pain.
Weakness in the shoulder and elbow: Difficulty lifting objects or performing certain movements.
Stiffness: Limited range of motion in the shoulder.
Occasional snapping or popping: You might feel or hear a clicking sensation in the shoulder.

Causes and Risk Factors

Bicep tendonitis is often the result of:

Overuse: Repetitive overhead activities, common in sports like tennis, swimming, and baseball, or certain occupations, can strain the biceps tendon.
Age-related wear and tear: As we age, tendons can weaken and become more susceptible to inflammation.
Sudden injury: A direct blow to the shoulder or a sudden increase in activity level can cause tendonitis.
Poor posture and mechanics: Incorrect lifting techniques or poor posture can contribute to shoulder strain.
Other shoulder conditions: Conditions like rotator cuff tears, shoulder impingement, and arthritis can sometimes be associated with or contribute to bicep tendonitis.

Diagnosing Bicep Tendonitis

A proper bicep tendonitis diagnosis is essential to rule out other conditions and determine the best course of treatment. The diagnostic process typically involves:

Physical Examination

A thorough physical examination by an orthopedic specialist is the first step in bicep tendonitis diagnosis. This examination includes:

Medical History Review: The doctor will ask about your symptoms, activity level, and any previous injuries.
Visual Inspection: Checking for swelling, bruising, or deformities around the shoulder.
Palpation: Gently pressing on different areas of the shoulder to pinpoint the location of pain and tenderness, specifically along the biceps tendon groove.
Range of Motion Tests: Assessing how far you can move your shoulder in different directions, both actively (on your own) and passively (with the doctor’s help). Limitations or pain during certain movements can indicate tendonitis.
Strength Tests: Evaluating the strength of your shoulder and arm muscles, particularly biceps strength, to identify weakness related to tendonitis.
Specific Orthopedic Tests: Provocative tests like the Speed’s test and Yergason’s test are commonly used to assess biceps tendonitis. These tests involve specific arm movements against resistance to elicit pain in the biceps tendon area, helping to confirm the diagnosis.

Imaging Tests

While a physical exam often provides enough information for a presumptive bicep tendonitis diagnosis, imaging tests may be used to confirm the diagnosis or rule out other shoulder problems.

X-rays: While X-rays do not show soft tissues like tendons, they can rule out bone problems such as fractures or arthritis that could be causing shoulder pain.
Ultrasound: Ultrasound imaging uses sound waves to create images of soft tissues, including tendons. It can effectively visualize the biceps tendon, showing inflammation, swelling, or tears. Ultrasound is also used to guide steroid injections accurately into the tendon sheath.
Magnetic Resonance Imaging (MRI): MRI provides detailed images of all shoulder structures, including tendons, ligaments, and muscles. It is highly effective in diagnosing bicep tendonitis and can also identify other associated shoulder conditions like rotator cuff tears or labral tears. MRI is often used when symptoms are persistent or if surgery is considered.

Differential Diagnosis

During bicep tendonitis diagnosis, it’s important to differentiate it from other conditions that can cause similar shoulder pain. These include:

Rotator Cuff Tears: Tears in the rotator cuff tendons can cause pain and weakness similar to biceps tendonitis.
Shoulder Impingement: Compression of tendons and bursa in the shoulder joint, leading to pain with overhead activities.
Shoulder Bursitis: Inflammation of the bursae (fluid-filled sacs) in the shoulder, causing pain and stiffness.
Osteoarthritis of the Shoulder: Degeneration of the cartilage in the shoulder joint, leading to pain and stiffness.
Referred Pain: Pain originating from the neck or upper back can sometimes be felt in the shoulder area.

Your orthopedic surgeon will carefully consider these possibilities during the diagnostic process to ensure an accurate diagnosis and appropriate treatment plan.

Treatment Options for Bicep Tendonitis

Once a bicep tendonitis diagnosis is confirmed, treatment aims to reduce pain and inflammation and restore normal shoulder function. Treatment approaches range from non-surgical methods to surgical intervention, depending on the severity and duration of the condition.

Non-Surgical Treatment

Non-surgical treatments are typically the first line of defense for bicep tendonitis and are effective for most patients.

Rest: The cornerstone of initial treatment is avoiding activities that aggravate your shoulder pain. This may involve modifying your exercise routine or work habits to allow the tendon to heal.
Ice: Applying ice packs to the affected shoulder for 20 minutes at a time, several times a day, helps reduce pain and swelling. Always wrap the ice pack in a cloth to protect your skin.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Over-the-counter NSAIDs like ibuprofen (Advil, Motrin) or naproxen (Aleve) can effectively reduce pain and inflammation. Your doctor may prescribe stronger NSAIDs if needed.
Steroid Injections (Cortisone Injections): Corticosteroids are powerful anti-inflammatory medications. A cortisone injection into the biceps tendon sheath can provide significant pain relief. However, steroid injections are typically used judiciously as repeated injections may weaken the tendon over time. Ultrasound guidance is often used to ensure accurate placement of the injection.
Physical Therapy: Once the initial pain subsides, physical therapy is crucial for rehabilitation. A physical therapist will guide you through specific stretching and strengthening exercises designed to:
- Restore Range of Motion: Gentle stretches to improve shoulder flexibility and movement.
- Strengthen Shoulder Muscles: Exercises to strengthen the biceps, rotator cuff, and surrounding shoulder muscles, providing better support and stability.
- Improve Posture and Mechanics: Guidance on proper posture and body mechanics to prevent recurrence of tendonitis.

Surgical Treatment

Surgery for bicep tendonitis is considered if non-surgical treatments fail to provide relief, symptoms persist, or if there are other associated shoulder problems. Surgical options are usually performed arthroscopically, a minimally invasive technique.

Arthroscopic Surgery: Shoulder arthroscopy involves inserting a small camera (arthroscope) and miniature surgical instruments through small incisions. This allows the surgeon to visualize the inside of the shoulder joint and address the biceps tendon and other structures.
Biceps Tenodesis: This is a common surgical procedure for bicep tendonitis. It involves releasing the damaged portion of the biceps tendon from its attachment point and reattaching the remaining healthy tendon to a different location on the humerus bone. Tenodesis effectively eliminates pain from the damaged tendon and restores normal function.
Biceps Tenotomy: In cases where the biceps tendon is severely damaged and not suitable for repair or tenodesis, a tenotomy may be performed. This involves simply cutting and releasing the biceps tendon from its attachment. While less invasive, tenotomy may result in a “Popeye bulge” in the upper arm due to the biceps muscle retracting. However, most patients regain near-normal strength and function after tenotomy with a shorter recovery time.
Biceps Tendon Repair: Direct repair of the biceps tendon at its attachment point is less common and typically reserved for young, active individuals with specific types of tears.

Surgical Complications and Rehabilitation:

Complications from surgery for bicep tendonitis are rare but can include infection, stiffness, tendon rupture (after tenodesis), or cramping (after tenotomy). Post-operative rehabilitation is crucial for a successful outcome. This usually involves a period of immobilization in a sling followed by physical therapy to regain range of motion, strength, and function.

Surgical Outcome:

The majority of patients undergoing surgery for bicep tendonitis experience good to excellent results. They typically achieve pain relief, improved range of motion, and the ability to return to their pre-injury activity levels.

If you suspect you have bicep tendonitis, seeking a professional bicep tendonitis diagnosis and discussing treatment options with an orthopedic specialist is the best course of action to alleviate your pain and restore your shoulder health.