Shoulder pain bicep

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

The biceps tendon has its origin at the superior portion of the scapula.

The long head of the biceps originates from the supraglenoid fossa. It then runs through a groove in the head of the humerus before connecting to the biceps muscle in the upper arm. The biceps muscle then connects via another insertion into the radial tuberosity. The biceps muscle is responsible for flexion and supination of the elbow.

Tendinitis is inflammation (redness, soreness, and swelling) of a tendon. In tendinitis of the shoulder, the rotator cuff and/or biceps tendon become inflamed, usually as a result of being irritated and/or compressed by surrounding structures.

Signs of these conditions include discomfort and pain in the upper shoulder or upper arm and/or difficulty sleeping on the shoulder. If tendinitis involves the biceps tendon (the tendon located in front of the shoulder that helps bend the elbow and turn the forearm), pain will occur in the front or side of the shoulder and may travel down to the elbow and forearm.

Diagnosis of tendinitis and bursitis begins with a medical history and physical examination.

The first step in treating these conditions is to reduce pain and inflammation with rest, ice, and anti-inflammatory medicines. Physical therapy incorporating therapeutic ultrasound and stretching and strengthening exercises are useful. If there is no improvement, the doctor may inject a corticosteroid medicine. While steroid injections are a common treatment, they must be used with caution because they may lead to tendon rupture.

The biceps tendon may rupture as a result of chronic tendinitis in the biceps tendon. Most often, these ruptures occur in patients older than 40 who have a long history of shoulder problems, such as impingement syndrome or other rotator cuff injuries.

In younger patients, the biceps tendon is sometimes ruptured during heavy weightlifting.

A sharp snap may be felt by the patient, followed by pain and weakness of the arm.

A bulge in the arm is then normally visible where the bicep muscle has detached from the shoulder blade and retracted towards the lower arm. ("Popeye's" sign")

There may be also some loss of elbow flexion strength.

Conservative treatment, which includes a therapy program of range of motion exercises, is usually all that is required to treat a ruptured biceps tendon.

There usually will be mild, permanent deformity in the biceps muscle, but most patients regain total range of motion and elbow flexion strength.

In patients younger than 40 who may work in jobs that require heavy lifting, surgery to repair the tendon is often recommended.

Physicians may also recommend surgery to repair the ruptured biceps tendon for those patients who are older than 40 who are still physically active.

However, a newer treatment for tendonitis may be more effective and prevent the need for surgery. Percutaneous needle tenotomy is a technique where a small gauge needle is introduced using local anesthetic and ultrasound guidance. The needle is used to poke several small holes in the fascia. This procedure is called "tenotomy." Tenotomy induces an acute inflammatory response. Then, platelet rich plasma, obtained from a sample of the patient's whole blood is injected into the area where tenotomy has been performed. Platelets are cells that contain multiple healing and growth factors. The result? Normal good quality fascial tissue is stimulated to grow with natural healing.

For more information about this procedure, visit our sister site:
Tendonitis provides reliable, accurate, and useful information on tendonitis treatment written by a board-certified rheumatologist. Learn more about how to get tendonitis relief using the most up-to-date methods.

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