Biceps Tendinitis and Injury
Anatomy of the Biceps
The Biceps Brachii (commonly called the biceps) is a muscle located at the front of the upper arm and attaches your arm bone (humerus) to your shoulder. It is the muscle that bumps up when you flex your arm and it functions to rotate your arm from pronation to supination (twist your palm upward), and to bend your elbow and shoulder.
Biceps means 'two heads' in latin and the muscle earns its name because it joins at the shoulder in 2 places with 2 different 'heads', know as the proximal biceps tendons because they are closest to the top of the arm. The short head of the biceps tendon originates at the coracoid process of the scapula (shoulder blade). The long head of the biceps originates just above the glenoid fossa (joint cavitiy) of the scapula (shoulder blade) and runs in front of the head of the humerus along the bicipital groove, like a rope through a pulley. The transverse humeral ligament runs over top of the long head biceps tendon, holding it against the humeral head. The 2 heads of the biceps then merge and go down the length of the upper arm. It attaches at the largest part of the radius (lower arm bone) at the elbow.
Both heads of the biceps muscle are attached to the shoulder bones with their respective tendons. These tendons can become irritated and inflamed from a strain or over use of the tendon. As a result, tendonitis, tenosynovitis or a biceps tendon rupture may occur.
Biceps brachii tendon damage, inflammation, strain, or a tear typically affects the long head tendon of the biceps, as it is much more involved with the biceps group of muscles and tendons. The biceps is a commonly injured area of the body due to the large range of motion and frequent use of the shoulder joint.
Biceps tendinitis, or bicipital tendinitis (also spelled tendonitis), is a painful condition that affects the fibres of the biceps brachii tendon. Tendinitis occurs when the biceps tendon experiences small tears, is irritated, and becomes inflamed. As tendonitis develops, the tendon shealth (covering) can become thicker due to the tough scar tissue that builds up during healing. This thickening makes the tendon less flexible and prone to further injury.
Biceps tendonitis causes pain in your arm and/or shoulder and may lead to more severe problems if left untreated. The tendon and its sheath can become bound together, a condition known as adhesive tenosynovitis, which can severely restrict the range of motion within the arm and shoulder. The walls of the tendon sheath can thicken which prevents the tendon from sliding through the opening that keeps it in place, a condition known as constrictive tenosynovitis. The bicep tendon can rupture, or tear, completely which may require surgery.
Biceps tenosynovitis is a common tendon injury that typically affects older athletes. The synovial sheath (outer covering) of the biceps brachii tendon becomes inflamed and swollen. This limits the biceps tendon's ability to slide through the sheath smoothly and can cause scar tissue to build up between the tendon and its sheath restricting movement even more.
Symptoms of Biceps Tendon Injuries
If you have biceps brachii tendonitis or tenosynovitis you may experience:
- Pain and tenderness at the front of the shoulder that may move down the upper arm.
- Pain that increases when lifting your arm out front or above the shoulder.
- Pain that often gets worse at night or upon awakening in the morning.
- Redness, swelling, and a sensation of heat in the area of the biceps tendon.
- Limited range of motion in the shoulder and the elbow.
With tenosynovitis you may also experience:
- A sticking feeling in the upper arm/shoulder.
- A crackling noise (crepitation) in the shoulder when the arm is moved as the tendon tries to move through the sheath.
With a biceps tendon rupture:
- You may hear or feel a snap at the top of the shoulder with sharp pain. When this occurs, pain in the shoulder may quickly disappear as the pull causing strain in the head of the biceps is reduced.
- Bruising midway down the arm to the elbow may be evident.
- A bulge at the bottom of the biceps is usually noticable.
- There will be weakness when you try to lift your arm or bend the elbow.
- If not torn completely, there may only be pain at the front of the shoulder.
Due to the biceps muscle's connection to the shoulder joint, other problems that may occur in conjunction with biceps tendonitis include injuries such as shoulder impingement, shoulder instability, tears in the glenoid labrum that can lead to frozen shoulder, arthritis, and rotator cuff tendon tears.
Causes of Biceps Tendon Injuries
In the majority of cases, wear and tear of the biceps tendon causes damage. This wear and tear is often due to overuse of the shoulder during many overhead activities that we perform in our daily lives, hobbies, and sports. With overuse, tendons can weaken with microtears that cause irritation, eventually leading to inflammation (tendinitis). When tendonitis develops over a long period of time from overuse, it is referred to as chronic tendinitis.
Biceps tendinitis often occurs with other shoulder conditions or injuries, usually with damage to the biceps tendons. A fall on an outstretched hand or a direct blow to the shoulder can cause acute tendonitis (tendinitis that comes on quickly) if the biceps tendon is damaged. If left untreated, both types of tendinitis may develop into tenosynovitis or a complete tear (rupture).
Specific causes of biceps tendonitis, tenosynovitis, and tears in the biceps tendon include:
- Sports that involve repetitive throwing, lifting or forceful contact such as swimming, baseball, tennis, gymnastics, and weightlifting.
- A torn transverse humeral ligament. This ligament usually holds the biceps tendon in the bicipital groove at the top of the humerus, but if torn, the tendon can slip out of the groove and become irritated.
- Work that requires repetitive overhead movements such as painting, hammering, and overhead lifting.
- Straining the biceps muscle or tendon due to overuse or unusual use.
- Having an ongoing or previous shoulder injury that may have not healed properly.
- Infection in the shoulder, sometimes following surgery, although this is a less common cause.
Do You Really have Biceps Tendonitis?
Your shoulder and arm connect into one ball-and-socket joint, involving 3 bones, and a large number of muscles, tendons, ligaments, connective tissues and synovial fluid. Biceps tendonitis usually occurs along with other shoulder related problems:
- Biceps tendon tear, then deformity of the arm (a "Popeye" bulge in the upper arm)
- Chronic shoulder instability
- Biceps Tenosynovitis, inflammation of the tendon sheath
- Arthritis of the shoulder joint, Osteoarthritis or Rheumatoid arthritis
- Tendinosis of the biceps tendon, caused by degeneration of the tendon from athletics requiring overhead motion or from the normal aging process
- Rotator cuff tear, a group of 4 tendons located at the shoulder acting as a 'cuff' to connect your humerus bone to the rotator cuff muscles. Acute trauma results from a sudden injury such as falling onto an outstretched arm, which can bruise, strain or tear your rotator cuff tendon(s) or muscle(s) at any age. Excessive force exerted by lifting or pulling something too heavy, pushing off an object vigorously with your arm, or making a forceful and abrupt forward throwing or overhead action, can also severely damage and tear your rotator cuff.
- Tears in the shoulder joint (Slap tear or glenoid labrum tear). There are 3 bones in the shoulder blade (scapula), the collarbone (clavicle), and the upper arm bone (humerus). Injuries to the tissue rim surrounding the shoulder socket(s) can occur from acute trauma or repetitive shoulder motion or injury. Falling on an outstretched arm, a direct blow to the shoulder, a sudden pull (ie. trying to lift a heavy object), or a violent overhead reach (ie. trying to stop a fall or slide) can cause a slap tear or labrum tear injury.
- Shoulder Bursitis is often due to overuse or overhead repetitive actions. It can also be a result of something as simple as an awkward fall or trying to lift something up high with a weakened shoulder. When pressure or friction is too great, excess fluid can build up in the bursa sac causing swelling and inflammation. Moving the shoulder becomes very painful and movement can be difficult. Any actions that put pressure on the inflamed bursa can increase irritation and cause further inflammation and pain. Symptoms of shoulder bursitis are pain, limited range of motion, weakness, difficulties sleeping, swelling and tenderness, and possibly a fever if the bursa is infected (septic shoulder bursitis).
- Calcific tendinitis A chemical reaction with other tissues in the body and calcium builds-up in the tendons. More common condition with women and the age ranges between 30 and 50. This is not a sport / activity related injury. It is known as a natural process than can occur in some people and not in others. The shoulder and rotator cuff are the typical location of calcific tendinitis - it is also know as calcific tendinopathy. Pain and stiffness that often comes back but usually last one to two months.
- Impingement Syndrome happens when the tendons in your shoulder get caught by the bones in your shoulder. Over time if left untreated impingement syndrome can result in shoulder tendonitis, bursitis and can cause tearing in your rotator cuff tendons. Like shoulder tendonitis, impingement syndrome can happen from repeated overhead activity or movement like painting, lifting, swimming and any other overhead sports. There are generally 3 stages in impingement syndrome: Stage 1 (pain, swelling and inflammation in the rotator cuff tendons), Stage 2 (rotator cuff tendonitis) and Stage 3 (tendon tissue catching under your bone resulting in immobility and loss of function in your shoulder). Each stage will generally affect a different age group, which is why this condition is thought to progress over time. Stage 1 usually affects individuals younger than 25 years old, Stage 2 affects individuals between the ages of 25 and 40, and Stage 3 affects individuals 40+ (reference: 1).
- Frozen shoulder (also known as "adhesive capsulitis") is signified by pain and stiffness in the shoulder joint, limited range of motion and pain while sleeping. This is a condition that commonly occurs in older athletes. Frozen shoulder is 5x more common in people with diabetes, though the reason for this is unknown. It's possible that frozen shoulder will happen as a result of a previous injury (like shoulder tendonitis), but it can also happen for no apparent reason or may be triggered by a mild injury in the shoulder area. There are 3 phases to this condition: "Freezing" (general pain, swelling and inflammation), "Frozen" (stiffness in your shoulder) and "Thawing" (recovery as pain eases and most of the movement returns). This process will take some time to get through, and can sometimes take as long as 2 or more years to complete.
- Diseases that cause inflammation of the shoulder joint lining - like Synovitis, Gout and Pseudo-gout.
How Do I Diagnose Bicipital Tendonitis?
Visiting your doctor when you have arm pain is always recommended, as there are many possible issues that can happen within the arm and shoulder joint.
To begin with, your doctor will gather a medical history about you and your current condition and symptoms. They will ask about the intensity of your pain, how long your symptoms usually last and the limitations you're experiencing. Details about when it started and whether or not you have ever had treatments for this or a similar condition in the past are very helpful in assessing your shoulder injury.
Your doctor will also look and feel the bones and soft tissue in both your shoulder and arm to find any differences between you injured arm/shoulder and your healthy arm/shoulder. This will help them to feel any abnormalities in and around your shoulder - like mild or severe inflammation, bone deformities, atrophied muscles (muscles that have wasted away due to injury), redness and/or warmth on the skin.
Your doctor might also perform one of the following physical tests;
Speed's test: Your doctor will press down on your arm as you hold it out with your elbow slightly bent and palm up.
Yergason's test: Your doctor will grip your hand and apply pressure on your arm while you bend your elbow 90 degrees (at a right angle).
For both tests pain in a specific area of the shoulder during will let the doctor know that you have biceps tendinitis.
Sometimes, one set of symptoms can result in multiple diagnoses. An X-ray, CT scan, MRI or visual ultrasound is often needed in order to diagnose if the area is out of alignment or the extent of the soft tissue damage.
It's important to have a proper diagnosis from a doctor or some other medical professional to determine the cause of your symptoms. This way the right treatment can be used to treat the condition and relieve your pain.
Non-Surgical Treatment for Biceps (Shoulder) Tendonitis
In most cases, your Doctor will start with non-surgical treatments options. Some of the options your doctor may recommend include drugs or medications like NSAIDs (non-steroidal anti-inflammatory drugs) to manage pain and inflammation. Alternative medications like cortisone injections are advised with caution for any type of tendon condition. This is because there is increased risk of rupture of the tendon following a cortisone injection.
"Medical evidence shows that cortisone shots can damage the surrounding tissue, fray the tendon, and even trigger a rupture. Most side effects are temporary, but skin weakening (atrophy) and lightening of the skin (depigmentation) can be permanent." (reference: American Academy of Orthopaedic Surgeons)
Biceps Tendonitis Treatment -
What You Can Do!
The good news is that most cases of bicipital tendinitis will heal with simple home conservative treatments and surgery is often not needed!
Step 1 - Reduce Pain and Swelling with Cold Compression
The first step for conservative treatment of your biceps tendinitis is to reduce the swelling to "open up" the area for more blood flow. Anyone in the health-care business knows that your blood supplies the oxygen and much needed nutrients required to heal biceps tendinitis injuries. This is why for years, doctors, trainers, and other medical professionals have recommended RICE (Rest, Ice, Compression, Elevation) to treat the pain and swelling of fresh injuries, chronic pain, and after any re-injury.
Although RICE can help to treat these symptoms, ice and freezer gel packs reach temperatures so low they can cause cryoburn, an ice burn on your skin. The problem is, up until now there hasn't been any other option to treat painful conditions and injuries, so ice and blue gel packs (full of anti-freeze and chemicals) have been the only choice up until now.
Fortunately you no longer have to settle for these ice cold methods that are uncomfortably cold against your skin, provide short term relief, cause ice burns, numb your skin and underlying tissue beyond feeling so you don't even notice the ice burn until it's too late and pool around your injury putting the cold everywhere except for where you need it most.
A Shoulder ColdCure Wrap® allows you to treat your biceps injury in an effective and convenient way. Our ColdCure Wraps® will fit your shoulder keeping the cold right over your biceps injury for the entire length of your treatment. Our food-grade, non-toxic gel packs can be chilled in the fridge or freezer to tailor the amount of cold that you need for your injury. It doesn't matter how you cool it down, because our gel packs are chock full of gel that's designed to cool down into millions of tiny snowflakes. This method of cooling means our gel packs aren't icy-cold and stay flexible even right out of the freezer! The cushioned gel will wrap around your shoulder and it won't budge for the entire treatment period. You'll no longer have to deal with annoying pooling around your shoulder or have to hold a hard block of ice on your injury!
Cold Compression Therapy slows nerve and cell function - reducing the swelling that blocks blood vessels from doing their job.
This is important because once blood vessels are blocked or damaged, they can no longer carry oxygenated blood through the tissue and tissue cells begin to break-down. Without cold compression therapy cellular break-down and tissue damage continues as the cells don't get the oxygen they need to survive. By limiting the amount of damage done to your biceps tendon, you also limit the amount of healing that needs to occur. This is a very important step to heal tendon injuries faster and with less pain! This is why you need to treat your shoulder / arm pain right after it's hurt, when you notice pain / swelling / inflammation, or directly after a re-injury. Applying a ColdCure Wrap® right away will stop the damage immediately and unblock your blood vessels to let your body's natural blood flow in to start healing the tissue.
Cold Compression Therapy = the Shoulder ColdCure Wrap®
It'll seem weird for you to read this, but there are a LOT of people out there that don't understand how fast cold compression with a Shoulder Freezie Wrap® can get the swelling / inflammation in your biceps under control! After you get rid of the swelling for good you can start dealing with your shoulder injury and pain head on.
Use a Cold Compression Side Shoulder ColdCure Wrap®:
- 24 to 72 hours after your initial tendon injury or when you first notice pain and swelling in your shoulder and arm to stop cellular damage, relieve pain, and decrease swelling.
- After exercise, workouts or activity of any kind to prevent re-injury of your biceps tendinitis.
- Before and after surgery during rehabilitation to control pre and post-surgery pain and swelling.
- Anytime you feel your shoulder or arm have been over-extended, over-worked, twisted, strained or sprained causing pain and swelling.
- Anytime you have swelling, sharp throbbing pain or inflammation in the tendons in your shoulder / arm.
- Any other situation where you need to draw the pain and inflammation out of your arm and shoulder.
If you have questions, call our office at 1-866-237-9608 (toll free continental US).
Step 2 - Improve Circulation, Soften Scar Tissue & Prevent Re-Injury with Blood Flow Stimulation Therapy
After the inflammation around your injured tendon has been reduced, you need to provide extra blood flow to strengthen your tendon tissue.
Promoting blood flow to your biceps tendinitis to help your body heal itself is a concept that has been utilized for centuries. Oxygen and nutrients, carried within the blood, are critical for the body to heal itself. Without proper blood flow, your recovery from biceps tendinitis will be delayed... sometimes for a very long period of time.
Even though the concept is simple, improving blood flow to your biceps tendon while it's injured can be difficult. Traditional methods require your arm to move in order to promote blood flow - but that same motion that promotes blood flow can also make your pain and tendonitis much worse. Relying on movement alone to increase blood flow puts you in danger of re-injuring your biceps
So what do you do when you need to increase blood flow, but you can't move your arm or shoulder without re-injuring your tendon?
Using Blood Flow Stimulation Therapy™ (BFST®), will help with your recovery and heal your tendon more completely. BFST® increases the amount of blood that flows naturally to your soft tissue to nourish your tendons, improving elasticity and speed up the healing process. This increased Blood Flow Stimulation Therapy to your biceps tendon(s) is greatly needed.
The only way to get BFST® is through use of a BFST Wrap®. The BFST Wrap® is the only treatment method that improves blood flow and circulation on a deep tissue level. Other methods of warming / heating tissue (hot water bottles, hot baths, etc) will only ever increase blood flow on a surface / skin level. These methods need a LOT of time to even reach your tendon on a deep tissue level. And even if you were to use them this long your skin would heat up to an uncomfortable level and may even burn you.
The best source of heat treatment is from a product where you don't even feel that much heat. When you don't feel the heat, it means the therapy is working in your deep soft tissue which is really where you need it. It's kind of like how your heart works in your body. You can't "feel" your heart pumping blood all around your body to your arms and legs. You can't even hear your own heartbeat without listening very closely. This is exactly how deep tissue BFST® works too! You're not supposed to "feel" a lot of heat because the heat isn't treating your skin, it's treating your bicep increasing the blood flow right in your tendon tissue.
- When treating bicipital tendinitis (shoulder / arm tendonitis) or any soft tissue injury, an effective therapy will increase blood flow to the injury while the joint is immobile.
- This increase in blood flow will accelerate the body's own ability to heal itself.
- The BFST Wrap® is the most highly effective blood flow stimulation device that you will find on the market that is approved by the FDA for use in the home or hospital.
Our BFST Wrap® is made from medical-grade material - this should be as important to you as it is to us! Other products that are sold in stores are considered "consumer goods" meaning the material only needs to be as good as a sweater that you wear. Clothing articles like this don't need to meet high standards of production or materials and may include materials that irritate your skin.
Since our wraps are medical-grade products registered with the FDA, they are of a higher quality and need to meet way more standards for manufacturing (ISO 10993 - bio-compatibility testing). This makes our wraps the safest product for heating treatment. Our manufacturer has spent years perfecting the wrap design to make sure you get the treatment you deserve!
Use a Side Shoulder BFST Wrap®:
- After swelling and inflammation have been reduced with cold compression.
- Before exercise or workouts to warm up the tendons in your biceps to prevent re-injury.
- Before and after surgery during rehabilitation to warm up your tissues before physical therapy exercising or stretching.
- Anytime you feel the tendons in your arm have stiffened up, are tight and your mobility is reduced causing you more pain.
- Anytime you have sore or aching tissue in your arm and shoulder.
- Any other situation where you need to increase blood flow to your bicipital tendinitis injury to relax your tendon, relieve pain, prevent re-injury and enhance flexibility of your tissue.
Use These Conservative Treatment Tools
to Deal with Scar Tissue
It's important to rest any soft tissue injury because our natural healing process takes time to heal completely. If you don't rest your tendon, your acute tendinitis can quickly turn into a chronic tendinitis injury. To repair our damaged tendon tissue quickly, our bodies will use scar tissue to fill in the tears in the tendon. If you need to rest for an extended period of time and avoid certain activities that make your pain worse, you'll be more likely to develop massive amounts of this scar tissue as a temporary healing measure.
Scar tissue may plague you for weeks, months and maybe even years, depending on your level of activity and the amount of conservative treatments you have done during your rehabilitation. Scar tissue is a major problem, especially when it comes to re-injury of your tendon. When dealing with scar tissue it's always important to:
- listen well to your physician and if conservative treatments are recommended, remember to stick to your (daily) treatment plan using these therapies.
- frequent use of the ColdCure Wrap® will help reduce the swelling very quickly. Much of the pain you feel will be from the swelling, and you'd be surprised how fast the pain drops off once the swelling is down.
- BFST Wrap® is a safe, electromagnetic energy device that will help reduce scar tissue and increase blood flow to the area (thereby accelerating the body's own healing process).
- when applied before stretching, the BFST Wrap® will help flush the area with fresh blood. This will help improve your range of motion and prevent re-injury.
It may seem hard to believe, but our ColdCure Wraps® and BFST Wraps® will assist you in recovering from your injury faster and reduce the chance suffering from degeneration conditions (like arthritis or tendinosis) by maximizing blood flow where it's needed most and reducing swelling / inflammation induced pain.
Prevention and Promotion of Lifelong Health
If you want to avoid re-injury, or manage pain and increase circulation for lifelong health benefits, a Shoulder ColdCure Wrap® and Shoulder BFST Wrap®, will provide exceptional results. Why spend time in pain, off from work, and missing out on your active lifestyle when you can be proactive about your injury and the health of your body? Talk to your doctor about incorporating a regular routine of using a Shoulder ColdCure Wrap® and Blood Flow Stimulation Therapy™ into your everyday health regimen.
Call one of our AidMyMuscle Advisers at no cost or obligation to address any lingering questions you have about using heat or cold for your shoulder injury - toll free 1-866-237-9608
Learn More About SUPERIOR Tendonitis Treatments
Learn more about how the Shoulder ColdCure Wrap® is designed to be the most effective cold compression wrap on the market today.
Learn more about how the Shoulder BFST Wrap® helps with the healing process.
Muscle Injury Facts:
There are approximately 639 muscles in the human body
Muscle aches and pains are common and can involve more than one muscle
Muscle pain also can involve ligaments, tendons, and fascia, the soft tissues that connect muscles, bones, and organs
Oral medications can mask the pain but do not aid in the healing of a muscle injury. Anti-inflammatories and pain killers can cause muscle related injuries to worsen
Muscle pain also can be a sign of conditions affecting your whole body, like some infections and disorders that affect connective tissues throughout the body
Most common cause of muscle aches & pains:
- Injury or trauma including sprains and strains
- Overuse: using a muscle too much, too soon, too often
- Tension or stress