The biceps brachii is a muscle located in the front of the upper arm. The biceps crosses two joints: glenohumeral joint (shoulder) and the humeroulnar joint (elbow) allowing the muscle to actively move both joints through flexion.
The muscle’s name is derived from the fact that the proximal portion of the muscle separates into two tendons (“bi”ceps). The long tendon passes through the intertubercular groove otherwise known as the bicipital groove near the top anterior portion of the humerus before attaching to the top of the glenoid fossa of the scapula. The shorter of the two tendons attaches to the coracoid process of the scapula.
Mechanism of Bicipital Tendinitis
The biceps brachii is actively involved in several motions of the shoulder including flexion, abduction (movement away from the body), and adduction (movement towards the body). According to Anderson, M.K., Hall, S.J., & Martin, M. in their text, Foundations of Athletic Training, (2009), “rapid overhead movements involving excessive elbow flexion and supination activities” are often the mechanism for biceps tendinitis.
Because the biceps brachii is a primary mover for both elbow flexion/supination and shoulder flexion, excessive movements of both of these motions can cause inflammation of the tendon. Inflammation of a tendon can cause pain during any of the movements in which the musculotendinous unit is active.
Activities that tend to place an individual at risk for bicipital tendinitis include racquet sports, baseball/softball (pitchers in particular), football (quarterback), swimming, and track and field (shot-put and javelin) (Foundations of Athletic Training, 2009).
In biceps tendinitis, pain will be felt through the motions of shoulder flexion, abduction, and adduction. If the individual continues to move the shoulder in these movement patterns, the inflammation will increase along with the pain.
A secondary effect of tendinitis is atrophy of the associated muscle. As the inflammation and pain increase, the individual will tend to use the arm less and be guarded in his/her movements. As activity lessens, the muscle itself will weaken and atrophy (decrease in size).
This scenario of inflammation, pain, and atrophy can progress into a chronic injury if steps are not taken to alleviate the condition. The challenge lies in patient compliance once the condition has been diagnosed.
Recognition of Bicipital Tendinitis
The individual will complain of pain in the anterior portion of the shoulder. The pain will increase with activity and decrease with rest. The long head of the biceps tendon is palpable directly under the anterior deltoid. The patient will complain of point tenderness directly over the tendon upon palpation.
Pain can also be felt by the individual when the shoulder is passively (moved by someone else) extended (slowly moved backwards) with the elbow in full extension (straight) and palm of the hand facing down (pronation). This places the tendon on stretch and will elicit pain as the shoulder is brought further into extension.
Manual muscle tests of the biceps will also reveal pain over the tendon when the muscle is actively contracted. Resisted shoulder flexion will elicit pain directly over the tendon and reveal possible weakness of the muscle.
Treatment of Bicipital Tendinitis
The best and most reliable care for tendinitis is to catch it early and restrict any movements that cause pain. Rest is the most important treatment in the initial stages of managing tendinitis.
Rest in combination with specific modalities will enable the tendon to calm down and the inflammation to decrease. Cryotherapy (ice pack, ice cup) is an important modality early in the treatment. Ice can be applied for 20 minutes several times a day to help decrease the pain and inflammation.
Anti-inflammatory medications (NSAIDS) are also used early in the initial stages of healing to assist with the inflammation.
Once the pain has started to subside, gradual stretching and strengthening exercises can be initiated. Care must be taken to not overstress the tissue during this phase as the inflammation can easily return. Once pain-free range of motion has been regained, the individual can resume activity.
Preventing a Recurrence of Tendinitis
Overuse and poor mechanics of the shoulder are the primary causes of tendinitis. To prevent recurrence, the individual needs to take a look at his/her performance mechanics and ensure that proper movement mechanics are in place.
Second, the individual needs to reduce the amount of repetitions of his/her activity. This can be done by reducing the number of repetitions (i.e., number of serves practiced) or the frequency of activity (reduce from five days a week to three days a week).
Proper mechanics combined with adequate rest will help ensure that the tendinitis does not return.
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