The Biceps Brachii muscle is the large muscle at the front of the upper arm – think Arnold Swartznegger, Dragon Ball Z and two tickets to the gun show. The muscle has two heads (known as the long and short head) that originate from the scapula (shoulder blade) before travelling down the arm and inserting below the elbow. As the muscle runs over two joints (the shoulder and the elbow), it has multiple functions. The main function of this muscle is to supinate (rotate) the forearm up and bend the elbow. Additionally, it has some role in assisting with shoulder elevation. The long head of the biceps (LHB) can become irritated leading to pain and dysfunction.
Long head of biceps tendinopathy is a disorder of the tendon at its proximal (upper) end. The tendon structure becomes compromised as a result of injury or overuse.
Long head of biceps tendinopathy (-pathy from the Greek apatheia meaning suffering, feeling) can be defined as a disorder of the tendon. Other terms that might be used are tendinitis or tendonitis. These suggest that there is inflammation of the tendon, however, recent research suggests that inflammation is rarely present in the condition. We now understand that tendinopathy pain is related to changes in the structure of the tendon. The strong collagen fibres that make up the tendon become disorganised and are replaced by weaker cells and the tendon becomes less tolerant to loading.
The majority of LHB tendinopathy occurs in conjunction with other shoulder conditions such as rotator cuff pathology/ tears and SLAP (Superior Labrum anterior to posterior) lesions. It can also be caused by instability.
People who are required to repetitively load the arms overhead for work or sport, for example, painters, swimmers and throwing sports such as cricket, can develop LHB tendinopathy. These activities can overload the tendon resulting in pain, inflammation and irritation. It can also occur as a result of an injury such as a fall or lifting a heavy weight.
It is important to understand that this can also commonly be seen as part of the normal ageing process.
LHB tendinopathy normally presents as pain at the front of the shoulder around the bicipital groove which can be painful with direct palpation. The pain can radiate down the front of the arm. If another shoulder pathology is present, as mentioned above, then there may also be a general non-specific ache around the shoulder.
Pain is often aggravated with overhead movements or lifting weights. There may be a weakness at the shoulder as a result of the pain and/or due to a concomitant injury.
Diagnosis is based on a thorough subjective and objective assessment by a physiotherapist or doctor. Ultrasound scans and MRI may also be used as part of the clinical assessment but are not always necessary.
Physiotherapy is the first line of treatment for LHB tendinopathy. Based on the assessment findings the physiotherapist, we will create a personalised rehabilitation plan consisting of advice/education, activity modifications and exercises. The aim of treatment is to restore normal function, reduce pain and improve load tolerance throughout the biceps tendon and shoulder. The rehabilitation plan will be tailored towards your personal goals and will include sport-specific rehabilitation exercises in the latter stages if appropriate.
If there is no improvement in your symptoms after a period of rehabilitation then more invasive treatment may be recommended. A corticosteroid injection around the tendon sheath can reduce pain and allow progression through the rehabilitation process.
Surgical management may be required if biceps tendinopathy occurs in conjunction with a SLAP tear or other shoulder pathology, or if no improvement is seen after a period of conservative management. Surgical procedures include biceps tenotomy and biceps tenodesis.
Our specialist shoulder physiotherapists are experienced in diagnosing and treating shoulder problems such as long head of biceps tendinopathy. They can help to determine the correct rehabilitation pathway for you and work out a treatment plan that suits your individual needs as well as provide advice, feedback and progression throughout your recovery. The sooner you get help, the quicker you can get back to what is important to you!