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Biceps Tendonitis/ Tendinopathy
What?
Tendons are strong bands of fibrous tissue that connect muscles to bone to allow movement of joints.
'Tendontis' is the term for an inflammed tendon and 'Tendinopathy' is the term for 'Wear and tear' of a tendon. The biceps tendon can also over time tear or rupture.
Why?
The biceps muscle is located in the front of the upper arm, and is used when lifting, bending the elbow, and reaching up over the head. The upper portion of the biceps muscle has two tendons; the long head and short head.
The long head crosses over the shoulder joint to attach to the top of the Glenoid ' Socket of the shoulder joint'.
Lifting, pulling, reaching, or throwing repeatedly can lead to biceps tendinopathy or even tears of the upper biceps tendon.
Patients with biceps tendinopathy typically have pain in the front of the shoulder. Pain may increase with lifting, pulling, or repetitive overhead reaching. Symptoms usually develop gradually with tendinopathy, although pain may start all of a sudden in patients with tendinitis or biceps rupture.
Who?
Tendinopathy is a common problem. The risk of developing tendinopathy increases with age and is higher in people who routinely perform activities that require repetitive overhead activities in work or sport.
In relation to the biceps tendon it is important to examine the shoulder joint for contributing underlying problems, particularly the rotator cuff.
Approximately
How?
Diagnosis:
Generally the diagnosis of biceps tendinopathy/ inflammation is made by clinical examination. Reproducing your pain on palpating the biceps tendon which can be felt at the the front of the shoulder along with Special examination tests also aid with the diagnosis.
Equally it is important to examine the rotator cuff tendons and subtle muscle imbalances/ tightness with the muscles around the shoulder.
Treatment:
Biceps tendinopathy/ inflammation can usually be treated without surgery.
The first line of treatment is targeted physiotherapy but generally the vast majority of patients require an ultrasound guided cortisone injection in conjunction with rehabilitation.
Surgery:
Surgical intervention is only indicated for persistent symptoms that have failed non-operative treatment.
This procedure is indicated for the treatment for partial or full-thickness biceps tendon tears, severe biceps tendonopathy, or biceps instability associated with a rotator cuff tears.
It is very common to have another shoulder problem that needs addressing that is contributing to biceps pain e.g. impingement or rotator cuff tear.
Generally there are two types of surgical procedure to treat 'biceps pain'; Biceps tenotomy and Biceps tenodesis. Biceps tenotomy releases the tendon from its attachment and biceps tenodesis pins the biceps tendon after releasing it. The type of surgery you have depends on factors like age and demand.
Surgery is usually performed key or through a small incision near the armpit crease.
Useful external
patient/ Sports physio info links:
Me?
Surgery to treat biceps generated pain should only be considered when your symptoms have failed to improve with non- operative measure which include a steroid injection and physiotherapy. Commonly there are other problems in the shoulder such as a rotator cuff tendon tear or impingement (bursitis) that contribute to your pain which will need treating.
Biceps Tenodesis vs Tenotomy?
Several studies and meta-analyses have been published, which show that >75% of patients are very satisfied with either operation. None of the studies have been able to show any difference between the operations on any of the outcome measures that we commonly use.
There is very little functional loss after biceps surgery. The main difference between the operations is the risk of developing a cosmetic popeye deformity of the biceps tendon. The risk of developing a popeye is around 30-40% vs 10% with a tenodesis. Whilst this deformity may be apparent the vast majority of patients, are seldom concerned by it.
Surgery is performed whilst you under a general anaesthetic which will be performed a Consultant anesthetist. You may be offered a intrascalene nerve block to help with pain. In some circumstances the surgery can be performed whilst you are awake under a nerve block.
General anaesthesia is very safe but still carries a small risk (<1%) of Heart Attack, Stroke, Deep Vein Thrombosis, Pulmonary embolism. Surgery is a day case and all being well you go home in a sling the same day,
It is important that you understand the risk of surgery which are outlines below:
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Infection (<1%)
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Nerve & Vessel damage (<1%)
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Persistent pain
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Cramping of muscle
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Stiffness/ Frozen shoulder
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Need for revision surgery