Bicep Tendonitis treatment in Indianapolis, IN and Mooresville, IN
Proximal Biceps Tendinitis
Proximal Biceps Tendinitis / Internal Rotation Deficit
In its early stages, the tendon becomes red and swollen. As the tendinitis progresses, the tendon and its sheath (covering) can thicken. The tendon in these late stages is often dark red in color due to the inflammation. Occasionally, the damage to the tendon can result in a partial or complete tendon tear, and then a “Popeye” deformity of the arm (large bulge in the upper arm).
In most cases, damage to the biceps tendon is due to a lifetime of normal activities. As we age, our tendons slowly weaken with everyday wear and tear. This degeneration can be worsened by overuse — repeating the same shoulder motions again and again. Many jobs and routine chores can cause overuse damage. Sports activities, particularly those that require repetitive overhead motion (swimming, tennis, and baseball), can also put people at risk for biceps tendinitis. Repetitive overhead motion may play a part in other shoulder problems that occur with biceps tendinitis. In these cases, patients almost always have a difficult time with internal rotation (activities behind the back like fastening a bra or looping a belt).
Most patients with biceps tendinitis can be treated successfully without surgery. This includes activity modification, anti-inflammatories, injections, and physical therapy. Physical therapy plays a vital role in treatment in order to stretch out the muscles and ligaments of the shoulder. Steroid injections are cautiously used in this condition because the medication can weaken an already-injured tendon, increasing the risk of rupture (tearing).
In cases where pain does not improve with non-operative treatments, surgery may be offered. The inflamed tendon is removed and the biceps is repaired. This surgery may be done through a minimally invasive arthroscopic surgery with a camera or with a small, open incision.
Proximal Biceps Rupture
For many people, pain from a biceps tendon tear resolves over time. Mild arm weakness or arm deformity (Popeye deformity) may not bother some patients, such as those less active and older. Treatment initially involves ice or cold packs for 20 minutes at a time, several times a day to decrease pain and swelling. Drugs like ibuprofen, aspirin, or naproxen can reduce pain and swelling, as well. Your doctor may recommend using a sling for a brief time. Avoiding heavy lifting and overhead activities prevent aggravating the injury. Physical therapy is also important to work on flexibility and strengthening exercises to restore movement and strength to your shoulder.
Surgery is an option in younger and more active patients, such as in athletes or manual laborers, who have more demands on their shoulder. Ideally, surgery is performed within 2 weeks of the injury because otherwise the biceps tendon scars into the incorrect position. Biceps tenodesis is a procedure in which the biceps is repaired to the bone, just below the shoulder, which relieves pain, and retains strength and function. Most of the time the surgery is begun arthroscopically (minimally-invasively) and then an open incision is made near the axilla (arm pit) to repair the biceps tendon back to the bone. This surgery is performed under general anesthesia and is almost always accompanied by a nerve block to help with pain after surgery. Some patients may notice the biceps muscle sink down slightly (Popeye deformity) due to the movement of the muscle. This change in position of the muscle rarely causes any weakness.
Proximal Biceps Tendinitis Surgical Treatment
A biceps tenodesis is a procedure in which the damaged portion of the biceps is removed and the remainder is repaired to the bone (see image below). The goal of this surgery is to relieve pain, while retaining strength and function.
In rare cases where a patient has very low activity level (older patient, very little lifting and/or tendinitis in the non-dominant arm), a biceps tenotomy may be offered. A tenotomy is a very quick arthroscopic procedure where the biceps tendon is cut and allowed to retract down the arm. Patients with a tenotomy tend to have more of a muscle bulge (Popeye deformity) and some can have cramping of the biceps muscle with activity. However, they retain the majority of their strength and motion.
The above procedures are done as an outpatient under general anesthesia. A pre-operative nerve block is given to help with pain after surgery.