As we age, the tendons that attach the biceps to the arm at the shoulder and at the elbow can become inflamed, sore, and even frayed due to overuse. This condition, biceps tendinitis, can lead to aches and pains that radiate up and down the length of the front upper arm.
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If you have biceps tendinitis of the shoulder, you may notice pain with overhand actions, such as house painting, lifting a heavy object over your head, swimming the crawl, delivering a tennis or volleyball serve, or pitching or throwing a baseball.
If you have biceps tendinitis near the elbow, the pain will be lower down on the arm. You may notice weakness and soreness when bending the arm at the elbow. Flexing your biceps muscle or curling when lifting weights may become difficult.
In both types of biceps tendonitis, you may notice soreness or difficulty rotating the forearm (palm up, palm down). Both types of biceps tendinitis can involve loss of arm strength, too, along with tenderness at the injury site.
Why Biceps Tendinitis is a Problem
In a worst-case scenario, an inflamed biceps tendon can tear or rupture, causing the biceps muscle to detach at one end from the bone to which it’s anchored. This tendon injury cannot repair itself; total ruptures require surgery.
If you’re an older adult who’s not very active, you may not be bothered much by a partial loss of arm strength and mobility.
However, relatively young and active adults will likely find this diminishment of strength unacceptable—particularly if it’s accompanied by the physical disfigurement of a bunched-up biceps muscle that’s lost its tension. (Picture a prominent “Popeye” muscle bulge showing up at either the elbow or shoulder, instead of where you’d normally find it.)
Athletes will find this injury to be a season-ender (and possibly a career-ender) unless they get surgery to repair the torn tendon and reattach the muscle. Even with a minimally invasive arthroscopic procedure, however, an athlete will require rehabilitation time and physical therapy.
The best way to keep active and healthy, and to avoid surgery, is to prevent the biceps tendinitis from happening in the first place—or to at least reduce the risk of your tendon damage advancing to the point where tears are likely to occur.
Biceps Tendinitis Prevention
All forms of tendinitis are more likely as people get older, due to normal age-related wear and tear. Tendon degeneration is a function of biological aging, and it’s not something you can avoid—though you can change your behavior to mitigate the damage.
If you’re over 30, the best thing you can do is to be realistic about how hard you can push your body. Don’t be careless. Properly condition yourself and you may be able to reduce the risk of getting injured. Some tips:
- Avoid dead lifts (and other movements that cause pain). Remember the old physician’s joke, “Doctor, it hurts when I do this”? The punchline is, “So stop doing that!” If a particular movement aggravates your tendinitis, consider refraining from it.
- Use proper form. If you can’t refrain from the offending arm movement, see an orthopedist or physical therapist to discuss safer ways to use your shoulder, elbow, or biceps. You may be able to strengthen your body in other areas, such as the back, abdomen, or legs, in order to take some of the strain off your arms.
- Build strength gradually. You don’t need to stop weight lifting, doing push-ups, playing sports, etcetera, but it helps to be more cautious when lifting heavy objects or increasing your reps, weight, or resistance. Don’t make sudden, big increases in how much you lift or carry; take care to build up your strength slowly.
- Warm up and stretch. Before using the affected arm, always warm up your muscles and tissue. Cool down and stretch afterwards to remain flexible.
- Take rest breaks. Intense workouts require rest and recovery so muscles and tissue have a chance to repair themselves. If you work your upper body and shoulders on Monday, make Tuesday a rest day for those muscles. Rest within a workout session too, between periods of lifting or movement.
- Quit smoking. Researchers have found an association between using nicotine and having an increased risk of tendon damage and rupture. Smoking damages your circulation, leading to slower healing.
- Maintain a healthy weight/BMI. Scientists have found a link between tendon damage and being obese. Some of this is mechanical (being overweight strains your tissue and bones). However, scientists have found some evidence indicating that being overweight may promote inflammation, which can create chronic tendon problems.
- Don’t overuse corticosteroids. Steroid injections can help reduce inflammation in tendons, but overuse of this therapy can actually harm tissue and promote tendon rupture.
- Practice good shoulder care. Shoulder biceps tendinitis is often associated with other shoulder injury and damage, including osteoarthritis, SLAP lesion tears, shoulder impingement, and dislocations. If you have past shoulder injuries like these, be aware of any pain or tenderness you feel, and see a doctor as soon as you notice any change. Talk to your orthopedic physician about ways to keep your shoulder healthy. (The same goes for elbow tendinitis: if you’ve had tennis elbow before, you may be at a greater risk for a biceps tendon tear now.)
Biceps Tendinitis Treatment
Biceps tendinitis can be diagnosed by an orthopedic physician, through a combination of physical exam and imaging (MRI and X-ray to rule out bone deformities or fractures).
Depending on how far along your tendinitis is, a specialist may advise conservative, non-surgical treatment or surgery (in the case of significant damage, tears, or rupture).
Options for treatment include:
- Refrain from painful activities, and take frequent breaks when working out or otherwise using the affected arm.
- Non-steroidal anti-inflammatory drugs like ibuprofen and naproxen may help control inflammation and reduce pain. Talk to a doctor before taking these regularly, as long-term ingestion, or taking high doses, can lead to gastrointestinal issues and bleeding.
- Icing your affected tendon area intermittently may help to reduce inflammation, pain, and stiffness. Other forms of cold therapy may also be helpful.
- Physical therapy. PT can help reduce pain, increase flexibility, and preserve or improve range of motion. A therapist can also talk to you about strengthening other parts of the body to help take the strain off the affected tendon.
- Corticosteroid injections. If pain is severe, you may benefit from the anti-inflammatory properties of steroids. However, overuse of this therapy can actually weaken tendons, leading to rupture.
- Arthroscopic surgery. Minimally invasive tendon repair involves reattaching a ruptured tendon to bone. Tenodesis involves cutting or trimming unhealthy or damaged tissue, then re-attaching the tendon to bone. Most minimally invasive surgeries of this nature have good results, as long as you follow your doctor’s instructions for resting and rehabbing the arm afterward.
Biceps Tendonitis can be treated. For more information call Coastal Othopedics in Corpus Christi, Texas today at (361) 994-1166.
Article written by: Rob Williams, MD