Biceps Tendinitis: Overview
The biceps muscle is located in the front of the upper arm and is attached
to the shoulder and lower arm bone. The muscle helps to control movements
of the lower arm and is involved in throwing movements like those associated
with football or baseball. Tendons attach the biceps muscle to points in
the shoulder and forearm. If the tendons are overused and become inflamed
or irritated, the condition is called tendonitis.
Repetitive overhead movement and activities like throwing a baseball or
swinging a tennis racquet are common causes of biceps tendonitis. Symptoms
may include:
How can I prevent biceps tendonitis?
The simplest way to avoid another episode of biceps tendonitis is to avoid the activity that caused it; of course, this may be impossible for the serious athlete. For these people, frequent breaks from the causative activity should become routine. It's also wise to reduce or stop the activity at first sign of pain and to ice the bicep and shoulder following each training session or game.
You can help prevent biceps tendonitis by following these simple recommendations:
Diagnosis
To properly diagnose biceps, your physician will check your shoulder for any tenderness or joint looseness. You may be asked to extend, raise, or rotate your arm to determine any range-of-motion limits. If necessary, your physician will order x-rays or a magnetic resonance imaging (MRI) scan for a more detailed look at the injury.
Conservative treatment for biceps tendonitis can include:
Avoid activity during the acute phase.
Apply ice or a cold pack to the injury for 15 to 20 minutes, 4 times a day for several days to keep swelling down.
Take ibuprofen (Advil, Motrin) to help reduce inflammation and pain.
When the acute pain is gone, start gentle stretching exercises as recommended by your doctor.
Begin strengthening exercises for your biceps, shoulder, and arm muscles as recommended by your doctor.
If conservative measures are not effective, arthroscopic surgery may be necessary. During arthroscopic surgery, an orthopaedic surgeon makes a few small incisions and inserts extremely small instruments to exam the tendons. If necessary, the surgeon can then make any necessary repairs.
Improving Sports Performance
The key to improving sports performance after recovering from biceps tendonitis is a proper a rehabilitation program, and adhering to some of those same principles after the injury is gone.
The single most important aspect of improving performance is stretching before and after you step onto the field, court, ice, or golf course.
Benefits derived from stretching include:
REHABILITATION FOR BICEPS TENDONITIS
As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important. The most common rehabilitation for biceps tendonitis often includes the following:
Avoid activity during the acute phase.
Apply ice or a cold pack to the injury for 15 to 20 minutes, 4 times a day for several days to keep swelling down. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.
Take ibuprofen to help reduce inflammation and pain.
When the acute pain is gone, start gentle stretching exercises as recommended by your doctor. Stay within pain limits. Hold each stretch for about 10 seconds and repeat 6 times.
Begin strengthening exercises for your biceps, shoulder, and arm muscles as recommended by your doctor.
Begin arm motions of your sport or activity as recommended by your doctor. (For example: passing a football, throwing a baseball, tennis strokes, golf swings).
Arthroscopic surgery may be necessary if the pain results from shoulder instability or from pressure on the tendon from the shoulder bones.
The major objectives of rehabilitation from biceps tendonitis are to improve the elasticity of the biceps tendon and to gradually increase pain-free range of motion. The following exercises should be performed once or twice daily:
Reach out and place the unaffected side hand on a corner of a table. Bend at the waist. Flex the injured side arm at the elbow and pull the injured side arm backward and upward as if sawing wood. Slowly bring the shoulder blades as close together as pain will permit. Slowly bring the injured side arm down to its beginning position. Repeat this sequence 10 times, at least three times daily.
Stand with the hand of the unaffected arm resting on the corner of a table and supporting some of the body weight. Slightly bend the knee on the unaffected side and extend the other leg sideways. Allow the injured arm to hang loosely over the unaffected side foot. By shifting the body weight, cause the relaxed injured arm to swing in circles to the fullest extent possible as limited by pain. Perform 25 swings in a clockwise direction. Allow the injured arm to cease swinging. Perform 25 swings of the injured arm in a counterclockwise direction. Repeat this sequence at least three times daily.
Stand in a doorway with affected side arm bent at the elbow and the palm of the hand against the doorframe. Turn the body away from the injured side hand until a stretching sensation is experience in the injured shoulder. Hold this position for 10 seconds. Return to the starting position. Relax for 10 seconds. Repeat this sequence 10 times at least 3 times a day.
Stand erect close to a wall. With the palm of the injured side arm turned so as to face you, slowly slide the forearm and then the upper arm up the wall by moving closer to the wall. Slide the arm upward to the point of initial significant pain. Hold this position for 10 seconds. Return to the starting position and relax for 10 seconds. Repeat this sequence 10 times, at least 3 times daily.
Roll a towel lengthwise. While standing erect, dangle the rolled towel down the back, holding it with the unaffected side hand. Reach behind the back with the hand of the injured side and grasp the rolled towel. Gently pull upward on the towel, raising the injured side arm until first significant pain in the injured shoulder appears. Hold this position for 10 seconds. Relax the arms while maintaining the grasp on the rolled towel for 10 seconds. Repeat this sequence 10 times at least three times daily.
Bend and raise the injured side elbow to shoulder height. Grasp the injured side elbow with the uninjured side hand. Gently pull the injured side elbow toward the opposite shoulder until limited by first significant pain. Hold this position for 10 seconds. Relax for 10 seconds. Repeat this sequence 10 times at least three times daily.
Stand erect with arms raised to shoulder height and palms up. Press arms backward until stretch is felt. Hold this position for three to five seconds, then relax for 3 to 5 seconds. Perform this exercise 10 times. The bicep as well as the muscles of the shoulder and upper chest are stretched by this exercise.
Stand erect with feet at about shoulder width. Raise injured arm at the shoulder with elbow bent and place the forearm behind the head. Grasp the injured elbow with opposite hand and draw it toward the center of the body until stretch is felt. Hold this position for 3 to 5 seconds, then relax for 3 to 5 seconds. Perform this exercise 10 times.
Stand with arms fully extended at sides while grasping 2- to 5-pound weights in each hand, held palm forward. Flex the arms at the elbow to approximately 100 degrees, or to the point of pain, whichever comes first. Hold this position for 5 to 10 seconds. Return to the start position. Rest for 5 seconds. Repeat this exercise 10 times. You can increase the weight as pain allows and strength develops.
Stand with elbows directed upward over the shoulders and with arms relaxed. Extend arms at the elbow so that the hands proceed upward to the point of pain. Hold this position for five seconds. Return to the starting position and relax for five seconds. Perform this sequence 10 times, 3 times daily. As pain permits, add weight by using hand-held dumbbells.
Lie on belly with hands extended along sides of the body. Raise the upper chest from the floor to the point of pain and hold this position for 5 seconds. Return to the start position and relax for 10 seconds. Repeat this sequence 10 times, 3 times daily.
Alternative exercises
During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:
REHABILITATION AFTER SURGERY
Your biceps tendonitis may require arthroscopic surgery to properly anchor the biceps tendon. Keep in mind that the soft tissue needs time to heal before exercise can begin.
A physical therapy program usually begins with range-of-motion and resistive exercises, then incorporates power, aerobic and muscular endurance, flexibility, and coordination drills.
Finally, patients develop speed and agility through sport-specific exercise routines.
The ultimate goal of surgery is to provide dynamic stability while maintaining full range of motion, so that athletes can return to competitive or recreational sports. Progress is assessed by the patient's perception of how stable the biceps/shoulder feels and by comparing the strength and stability of the injured and uninjured arms.
How long will the effects of my injury last?
With proper rehabilitation, a first occurrence of biceps tendonitis diagnosed and treated in its early stages usually lasts two weeks. If the injury has recurred several times, or if surgery is necessary, full recovery may take as long as two months.
When can I return to my sport or activity?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your biceps tendon area recovers, not by how many days or weeks it has been since your injury occurred.
You may safely return to your sport or activity when:
