The junction between the muscle and the tendon of the biceps (bicipital tendon) is particularly susceptible to repetitive stress injuries, especially in individuals performing lifting / throwing activities. Gym fanatics and body builders who perform bench presses and dips, frequently suffer from bicipital tendinitis. Degenerative changes associated with aging also predispose the elderly patient to injury. At times this condition is confused with a rotator cuff tendinitis. The patient's history often suggests the diagnosis. Patients with bicipital tendinitis typically describe pain in the region of the anterior shoulder or occasionally radiating down to the elbow.

Treatment of Bicipital Tendonitis

Bicipital tendonitis is aggravated by activities that require shoulder flexion, forearm supination, and / or elbow flexion. The symptoms are alleviated by rest, ice, massage, stretching, and, sometimes, heat.

Pain usually is exacerbated on initiating activity but improves as the activity continues. Individuals often can fight through the pain and have it disappear as activity is continued; the pain then may return after the patients cease the activity. Pain may emerge in a delayed fashion after vigorous exercise involving the upper extremity.

Physiotherapy should be administered according to the stage of the tendonitis. In the immediate acute stage, one should start with rest, ice, compression and elevation (the classic RICE); stop the offending maneuver that aggravates the tendonitis and mild stretching and exercise program for the biceps. In the subacute stage transverse frictions should be started to release the tendon from any adhesions, ultrasound therapy to minimize the inflammation, moist heat to facilitate movement, perform gradual isometric exercises progressing towards concentric exercises. An exercise regime should then be administered to ameliorate proprioception and eccentric strength , with special emphasis on closed kinematic chain exercises at first progressed to open kinematic chain exercises.

In chronic conditions physiotherapy should continue as described above but further investigations should be done to eliminate other concomitant factors like bony or labral abnormalities or neurological symptoms.

Injection with anesthetic and corticosteroid into the biceps tendon sheath is another way of reducing the inflammatory reaction of the tendon and thus the pain.

In rare cases where everything else has failed to reduce the symptoms surgery may be required. This involves decompression of the musculotendinous structure through tenolysis under arthroscopical guidance or using an open surgical technique.

Bicipital tendinitis can be subdivided into the following 4 categories, defined by the occurrence of pain:

• Pain after activity only
• Pain at the start of activity that disappears with use, returns after activity, but does not limit activity
• Pain at the start of activity, which persists during and after the activity and restricts activity
• Pain that progresses during everyday activities

Read more about Tendonitis

Tendonitis

• Involves inflammation of the tendon, as well as the paratendon
• Results from a chronic overload, leading to microscopic tears in the tendon that trigger an inflammatory response
  

Peritendinitis/tenosynovitis

Inflammation of the paratendon or tendon sheath

• Usually occurs as a result of a direct injury or irritation where the tendon rubs over a bony prominence
  
  

Tendinosis

• Degenerative change in the tendon is noted, and histologic examination reveals angiofibroblastic degenerative changes in the tendinous attachment.
• Inflammatory mediators usually are not present, but often this symptom may coincide with tendinitis.
• The biceps brachii have 2 heads.