Albury Osteopath Cameron Bayliss discusses the often forgotten cause of shoulder pain…..biceps tendinopathy
What is the bicep tendon?
Your bicep tendon is an incredibly strong, fibrous piece of connective tissue that connects your bicep muscle to the shoulder blade (proximally) and the radial tuberosity (distally). Patients most commonly present with a proximal tendinopathy or impingement.
Because of the attachment of the tendon going through to the superior part of the shoulder blade it can cause pain in the back or even sides of the shoulder as well as the front.
Shoulders are a notoriously unstable and complex joint, meaning obtaining a specific diagnosis can be difficult, so visit one of our fantastic osteopaths for testing and advice on your shoulder pain. Because of this complexity, bicep tendinopathy can occur simultaneously with a rotator cuff tear and impingement.
FUN FACT! – There are 17 muscles that attach to one shoulder blade!
Causes
Most tendinopathies are caused from overuse or increasing training levels faster than our bodies can adapt and recover, the biceps tendon is no different. We commonly see people with these issues who are desk workers, casual gym goers and even gym junkies. Bicep tendinopathies are also seen in people with ‘upper cross posture’ which outs a lot of strain on the anterior shoulder.
Signs and symptoms
- Bicep tendon pain may feel like a burning or deep ache pre-activity or first thing in the morning, making it difficult to lift your arm or bend your elbow.
- Typically the pain will decrease during activity – only for it to come back a few hours later.
- These injuries get progressively worse over time – can build up for weeks and months.
- Pain is often in the front of the shoulder joint, but can aggravate pain all over the shoulder joint.
- Limited elbow and shoulder flexibility particularly in flexion.
- The area may be warm, tender and inflamed.
- A feeling of stiffness in the shoulder
- Loss of strength.
- If the pain is in the middle of the muscle belly then it is much more likely to be a muscular strain than a tendon rupture, this also often has a specific pain onset/incident.
Differential Diagnoses
- Rupture of the bicep.
- Pectoralis major tears.
- Rotator cuff impingement/tears/tendinopathies.
- Pain referral from neck or chest.
What do I do with initial occurrence?
- If you suspect a tendinopathy it is important to not completely rest it or immobilise it. That being said P.E.A.C.E. can help reduce pain and inflammation immediately after activity.
- Do not put your arm in a sling.
- Try and keep movement throughout the day, don’t get stuck at the keyboard for hours on end.
- Book in with your osteopath ASAP for assessment and treatment. The longer your problem hangs around, the longer it takes to recover from it.
How is it diagnosed?
With thorough history taking and examination, combined with orthopedic testing our osteopaths will have a confident diagnosis. Imaging is rarely required, however an ultrasound or MRI may be warranted in severe cases where rupture might be a concern.
How long will it take to heal?
Tendon recovery is typically quite difficult to judge healing time greatly varies based on the level of tissue damage. There are many factors that can influence healing times such as :
- Compliance with exercise.
- Level of aggravating activities.
- Age.
- Occupation.
Recovery isn’t typically a constant positive direction, there will be periods of flare up and discomfort that should get less severe and less frequent over time. Tendons can typically take anywhere from 4 weeks to 4 months, but severe cases may take longer. You can expect relief in the short term with treatment and pain management strategies.
Treatment of bicep tendinopathy
At Sports & Spinal Albury, our Osteopaths we are expertly trained to assess your biomechanics, both locally and throughout the rest of your body, then use some of our many manual therapy techniques to help address any causes or issues we find. We are passionate about helping you understand why the injury has occurred and what can be done to help it recover.
- The primary treatment plan involves a series of progressive exercise loading as we look to rebuild the strength of our tendon from the ground up.
- There are many phases of this, starting with pain-free tendon loading exercises such as isometric holds under a state on concentric tension before moving into pain free concentric repetitions and then building on eccentric control.
- We then look to restore your control, power, proprioception and agility, aimed at reducing the risk of recurrence.
- Once we’re confident your tendon has the strength required we can tailor a return to sport or activity program to help prevent further aggravation in the future.
- Our clinic now has new radial shockwave technology which has shown high level evidence in pain reduction for shoulder tendinopathy as well as other tendinopathies in the body. In fact, ours is the only machine with 27 level 1 studies completed on it. For more information visit our blog here ….
Dr. Cameron Bayliss
B Hlth Sc, B App Sc (Osteopathy)
