Biceps Tendon Specialist

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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

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What is Bicep Tendinitis?

Bicep tendinitis is a condition characterised by inflammation or irritation of the upper biceps tendon, a structure connecting the biceps muscle to the bone in the shoulder socket. It leads to pain and weakness in the front of the shoulder.

The biceps muscle, located in the front of the upper arm, plays a role in lifting, bending the elbow, and reaching overhead. Bicep tendinitis often arises from repeated physical activities involving the shoulder, leading to overuse and strain of the tendon.

Causes of Bicep Tendinitis

Understanding the causes of bicep tendinitis can aid prevention and treatment. Factors leading to this condition include:

  • Overuse and Repetitive Motion
    The most common cause of bicep tendinitis is repetitive shoulder actions, particularly those involving lifting, pulling, reaching, or throwing. This includes sports or occupations requiring frequent and repeated use of the arm.
  • Ageing and Wear and Tear
    As individuals age, the tendons naturally weaken due to wear and tear. This degeneration, coupled with continuous repetitive actions, can lead to tendon inflammation or even rupture.
  • Direct Injury
    Bicep tendinitis can result from direct trauma, such as a fall onto the shoulder. Such an impact can lead to immediate tendon damage or contribute to long-term degenerative changes.
  • Associated Shoulder Problems
    Conditions like rotator cuff tears, shoulder impingement, or instability often coexist with bicep tendinitis, either as contributing factors or as a result of the altered shoulder mechanics they cause.
  • Degeneration of the Tendon
    Over time, the collagen fibres within the tendon can lose their normal arrangement, leading to structural weakness, inflammation, and in some cases, a rupture of the biceps tendon.

Symptoms and Signs

The symptoms of bicep tendinitis can vary depending on the severity of the condition. Common indicators include:


  • Localised Pain: The most prominent symptom is a deep, aching pain located at the front and top of the shoulder. This pain often radiates down into the main part of the biceps muscle.
  • Exacerbation with Movement: Pain and discomfort often worsen during overhead activities or movements that strain the shoulder, such as lifting or reaching.
  • Weakness in the Arm: Individuals may experience weakness, particularly when attempting to bend the elbow or twist the forearm (supination).
  • Sensory Symptoms: A catching or slipping sensation near the top of the biceps muscle can suggest a tear of the transverse humeral ligament, often associated with bicep tendinitis.
  • Audible Signs: An occasional snapping sound or sensation in the shoulder can also be a sign of this condition.

Diagnosis

Diagnosing bicep tendinitis involves an assessment of medical history and a physical examination of the shoulder. The doctor may perform specific tests to evaluate the shoulder for related issues such as labrum tears, rotator cuff problems, or impingement.

Imaging tests can help confirm the diagnosis. X-rays, while primarily showing bone structures, can reveal signs like bone spurs that may impact the tendon. Magnetic Resonance Imaging (MRI) is another effective tool for detailed visualisation of the biceps tendon and surrounding structures.

Non-Surgical Treatment Options

The initial approach to treating bicep tendinitis is usually non-surgical, focusing on relieving symptoms and promoting healing.

Rest and Ice

The initial step in treating bicep tendinitis involves avoiding activities that exacerbate pain. Applying cold packs for 20 minutes several times a day helps reduce swelling and pain​​.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, aspirin, and naproxen are used to alleviate pain and inflammation. Use these with caution, as there is a potential for side effects such as stomach, kidney, or liver issues.

Topical creams containing pain relievers are also an option for localised relief without systemic side effects​​.

Steroid Injections

Cortisone, a potent steroid, can be injected around the tendon to ease tendinitis pain.

Repeated steroid shots can weaken a tendon and are not ideal for tendinitis lasting more than three months​​​​.

Physical Therapy

Targeted exercises, including eccentric strengthening, help strengthen the muscles and tendons. Eccentric strengthening emphasises contraction of a muscle while it’s lengthening, proving effective in chronic tendon conditions​​​​.

Platelet-rich Plasma

This treatment involves using the patient’s blood, separating platelets and healing factors, and injecting them into the area of chronic tendon irritation.

Dry Needling

Performed with ultrasound guidance, this procedure involves making small holes in the tendon with a fine needle to stimulate healing factors​​.

Surgical Treatment Options

Surgery for bicep tendinitis is considered when non-surgical treatments do not provide relief or in cases with associated complex shoulder problems.

Biceps Tenodesis

This surgery treats biceps tendon tears and SLAP tears (tears in the labrum). The procedure involves detaching the biceps tendon from the labrum and reattaching it to the upper arm bone (humerus)​​​​.

The technique includes making an incision at the top of the biceps tendon, releasing it from the labrum, drilling a hole in the upper arm bone, and securing the tendon in the bone using a suture anchor​​.

Biceps Tenotomy

As an alternative to tenodesis, in a tenotomy, the biceps tendon is cut away from the labrum but not reattached to the upper arm bone. This procedure is less invasive but may lead to a prominent bulge in the arm, known as Popeye syndrome​​.

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Prevention Strategies

Preventing bicep tendinitis involves strategies to reduce stress on the shoulder and biceps tendon.

  • Proper Technique and Equipment Use - Whether in sports or daily activities, using the correct form and technique can prevent the biceps tendon from overloading. Athletes, especially those in sports involving throwing or overhead activities, should receive proper training to avoid undue stress on the shoulder.
  • Regular Exercise - Strengthening the muscles around the shoulder can provide better support to the biceps tendon. Incorporating exercises that target shoulder stability and biceps strength can be beneficial.
  • Adequate Rest and Recovery - Allowing sufficient time for rest and recovery between intense activities helps prevent overuse injuries. This is necessary for athletes or individuals engaged in repetitive shoulder motions.
  • Ergonomic Workplace Adjustments - For those whose jobs involve repetitive arm movements, ergonomic adjustments can make a difference. Ensure workstations are set up to minimise shoulder strain.
  • Warm-up and Stretching - Proper warm-up exercises before engaging in physical activity and regular stretching can increase flexibility and reduce the risk of tendon injuries.
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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.

  • Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
  • Member, Royal College of Surgeons of Edinburgh (MRCSEd)
  • Master of Medicine (Orthopaedic Surgery), National University of Singapore
  • Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
  • Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany

 

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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
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Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed

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    Mount Elizabeth Novena Specialist Centre
    38 Irrawaddy Road, #08-62/63
    Singapore 329563

    Frequently Asked Questions (FAQ)

    What is bicep tendinitis?

    Bicep tendinitis is inflammation or irritation of the upper biceps tendon, characterized by pain and weakness in the front of the shoulder.

    What causes bicep tendinitis?

    It’s commonly caused by repetitive shoulder motions, ageing-related wear and tear, direct injuries, and associated shoulder conditions like rotator cuff tears.

    How is bicep tendinitis diagnosed?

    Diagnosis involves a medical history review, physical examination, and imaging tests like X-rays and MRI.

    What are the treatment options for bicep tendinitis?

    Treatment includes rest, ice, medications, steroid injections, physical therapy, and in more severe cases, surgical interventions like biceps tenodesis or tenotomy.

    Can bicep tendinitis be prevented?

    Yes, through proper exercise, technique, adequate rest, ergonomic adjustments, and listening to your body to address early signs of discomfort.