Upper biceps tendon, also known as the long head of the biceps tendon, connects your biceps muscle to your shoulder bone. When the swelling, soreness, and irritation in it, causes pain and weakness in the front part of your shoulder, you are said to have biceps tendinitis.

Anatomy

Three major bones i.e. the upper arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle) make up your ball and socket joint.

Your shoulder joint moves with the help of your upper arm bone, fitted into a socket i.e. glenoid, in your shoulder blade.  It is the cartilage labrum that covers the glenoid and the four muscles and tendons called rotator cuff that keeps the upper arm bone firm in the socket.

The front of your upper arm is made of muscles called the biceps. The biceps has two tendons, the long head of the biceps tendon and the short head of the biceps tendon. The long head of the biceps tendon, attached to the glenoid sustains biceps tendinitis.

Explanation

When the long head of your biceps tendon becomes inflamed, it is said to be biceps tendinitis. This condition progresses gradually.

• In the initial stages, the biceps tendon becomes swollen.
• As it worsens, the biceps tendon and the tendon sheath become thick and grow in size.
• In the last stages, the tendon may become dark red in colour and sustain a tear in the biceps tendon or result in the deformity of the arm in the form of a bulge.

You are likely to suffer from other shoulder problems when you have biceps tendinitis. The conditions may include glenoid labrum tear, dislocated shoulder, arthritis of the shoulder, rotator cuff tear or shoulder impingement.

Causes

The causes that may result in biceps tendinitis are-

If you are suffering from osteoarthritis or rheumatoid shoulder joint arthritis your tissues may become inflamed. This inflammation may extend to your upper biceps tendon causing biceps tendinitis. You may sustain biceps tendinitis if you are suffering from rotator cuff tears or glenoid labrum rupture.

With increasing age, your tendons tend to become weak and frayed. If you are involved in activities that demand you to move your shoulders repeatedly every day, the tendons may degenerate and result in biceps tendinitis. This may include regular work activities or over indulging in sports.

Any traumatic injury sustained during sports or a direct blow to the upper biceps tendon as in a vehicle collision may also cause biceps tendinitis.

Symptoms

• You may feel shafts of intense pain in the front part of your shoulder, more so, when you try to lift any object or your arm over your head.
• The pain will extend to your upper arm bone.
• You may hear a snapping sound when you try to move your shoulder.
• You may feel no pain when your shoulder and arm are relaxed.
• If your biceps tendinitis is severe, you may notice a reddish mark over your upper biceps tendon.

Diagnosis

The diagnosis of biceps tendinitis is divided into two parts i.e. doctor’s examination and imaging tests.

Doctor’s examination- After understanding your symptoms and your medical past the doctor will conduct a physical examination of your shoulder to test its mobility and strength. He may also check how well your biceps are functioning by performing certain specific tests.

Imaging tests- Besides the physical examination, the doctor will ask you to undergo some imaging tests to confirm his diagnosis. These include-

X-ray- An x-ray does not show the soft tissues inside the body. It only provides a detailed study of the bone structure but your doctor will ask you to undergo an x-ray to gauge if there are any other problems in your shoulder.

MRI- Magnetic Resonance Imaging will help the doctor to see your biceps tendon in detail. By comparing the length of the biceps tendons of both arms, the presence of tendinitis will be confirmed.

Arthroscopy- This procedure can be advised by the doctor if all other imaging studies have not been able to give conclusive details about the presence of biceps tendinitis.

Treatment

Your treatment method may be a combination of conservative and surgical methods. The severity of your damage and the possible presence of any other shoulder problems affect the decision.

Non-Surgical Treatment Techniques

Your shoulder doctor may begin your treatment with non-surgical methods that may include-

NSAIDs- Your doctor may prescribe some non-steroidal anti-inflammatory medicines to lessen the pain and the swelling in your shoulder.

Steroid Injectable- Besides the NSAIDs, your doctor may inject anti-inflammatory cortisone injectable in your shoulder joint to relieve you temporarily from the pain.

Opioids- If NSAIDs are not bringing down your pain, your doctor may under rare cases, prescribe opioids that will help reduce the intense pain.

Therapy- Some strengthening and range of motion exercises to improve the movement of your biceps muscle may also be a part of your conservative techniques.

Cold treatment- Your doctor may ask you to apply a pack of ice for 25 to 30 minutes, several times a day, on your shoulder to reduce the swelling.

Routine Changes- When moving your arm, the chances of the biceps tendon rubbing with the joint surface are higher, you may be cautioned against moving your shoulder and arm.

Surgical Treatment Technique

If your pain and swelling do not reduce even after weeks of treatment your doctor may advise surgical intervention that includes-

Arthroscopic Surgery- When your tendon is torn mildly it may be treated arthroscopically by your shoulder surgeon.

Open Surgery- If your biceps tendinitis is severe your surgeon may recommend a more lengthy procedure i.e. open surgery.

Biceps Repair- In this invasive surgical technique your surgeon will make a small incision on your shoulder joint and after approximating the two ends of the ruptured tendon, will join them together.

Biceps Tenodesis- Under this procedure the part of the biceps tendon that is damaged is removed and the healthy remaining tendon is reattached to your humerus. It may be done either arthroscopically or under open surgery.

Biceps Tenotomy- If your biceps tendon is critically damaged it may be irreparable. Your surgeon may decide to cut off the tendon completely from the humerus, leaving a Popeye bulge on your arm.  This technique can either be performed arthroscopically or lengthily depending on the graveness of your tear.

Shoulder Arthroplasty- If your pain is persistent and severe despite having surgically treated your shoulder surgeon may recommend replacing your entire shoulder joint. This method is known as shoulder arthroplasty.