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Orange indicates inflamed biceps tendon

The biceps muscle of the shoulder (lat. musculus biceps brachii) is a large muscle of the shoulder, clearly visible under the skin, which is why it is widely known even among people who are new to anatomy. The muscle has two bundles of contraction. It participates in flexion of forearm and flexion of shoulder, reducing one or the other bundle. The upper part consists of two heads – long and short. The long head starts from the supraglenoid tubercle of the scapula with a long tendon which is passing through the cavity of the shoulder joint. The short head begins from the coracoid process of the scapula, both heads are connected to form the muscle’s abdomen, which ends with a tendon attached to the tuberosity of the radius.

One of the most common causes of pain in the shoulder joint is tendonitis of the tendon of the long biceps head. In this case, the inflammatory process develops in that part of the tendon that attaches to the shoulder joint. Most often, the disease subsequently appears after loading it too much or when performing a certain type of work or when playing sports. A similar condition may be due to wearing off of the shoulder joint. The most important sign of tendinitis of the long bicep head is pain, which is dull. Often, pain syndrome is localised in the front of the shoulder, but sometimes it drops lower to the area where the biceps muscle is located. Pain sensations intensify during the movement of the limb, especially if it is lifted. When the limbs are at rest, the pain subsides. There is also a weakness when turning forearm and flexing the elbow joint.

The diagnosis is established after collecting a detailed medical history, as well as the results of clinical examination. During the examination, special clinical tests are carried out that help to distinguish one disease of the shoulder joint from another. Sometimes it’s difficult to distinguish between tendonitis of the biceps tendon, for example, from impingement syndrome. In such cases, an ultrasound or MRI scan is performed.

MRI for tendinitis of the long biceps head. Arrows indicate signs of inflammation.

Arthroscopy can also be one of the methods for diagnosing and treating shoulder joint. This is a fairly minimally invasive treatment method. During arthroscopy, it is possible to look into the joint and see its internal structure. An arthroscope is a small optical device that is introduced into the joint through a puncture in the skin and allows to diagnose and treat injuries and diseases of the biceps tendon, rotational cuff, and articular lip.

Arthroscopic picture of a healthy (left) and inflamed (right) tendon of the long biceps head

Treatment

Traditionally, treatment of tendonitis of the biceps tendon begins from conservative methods.

Treatment usually begins with limiting workload, giving up sports or work that led to the disease. Anti-inflammatory drugs help reduce pain and swelling. After reducing pain and swelling syndrome, the gradual development of movements in the joint begins. Injections of hormonal drugs into the joint cavity can be used, which dramatically reduce joint pain. However, cortisone injections in some cases can further weaken the tendon and lead to its rupture.


Injection of a hormonal drug into the tendon

An auxiliary method of treatment is Kinesio taping, which will help relieve the inflamed area and relieve pain.

An alternative treatment for tendonitis today is through injections of the patient’s platelet-rich plasma (PRP therapy). Platelet plasma is released from the patient’s blood and then introduced into the area of the inflamed tendon. In this case, all side effects from the introduction of hormonal drugs are levelled. Platelets stimulate tissue repair, trigger the growth of new blood vessels. As a result, tendon tissue is restored and pain disappears.

Preparation of platelet-rich plasma

Surgical treatment is usually offered if conservative treatment is ineffective for three months. Most often, surgical treatment is acromioplasty. During the operation, which the surgeons perform using arthroscopy, the anterior portion of acromion is removed. This makes it possible to expand the distance between the acromion and the adjacent head of humerus, thus reducing pressure on the tendon itself and surrounding tissues.

If the patient has severe degenerative changes in the tendon, then biceps tenodesis is performed. This method consists in reattaching the upper lobe of the biceps tendon to a new location.

Operation tenodesis of the long head of biceps. Cutting off the inflamed tendon from the attachment point (right), followed by fixation in the inter-tubercle groove.

After the operation, rehabilitation lasts for about six to eight weeks. A positive outcome will largely depend on the patient himself, that is, on his mood for a good  result. Doctors do not recommend bedding, shortly after surgery you need to start physical therapy classes.

A physiotherapist will select a set of exercises and monitor the process of strengthening the muscles of the shoulder and forearm. Usually, positive dynamics are observed after two to four weeks.

If a patient faithfully fulfils all the recommendations of the attending physician, then the full restoration of the shoulder and forearm will take in three to four months.