January 13, 2013
Many patients visit our Burlington physiotherapy and chiropractic clinic for assistance with pain in the front of the shoulder. There are various causes to pain in this area, but perhaps one of the leading suspects would be the bicep tendon.
As the name implies, the bicep tendon has two heads. In the shoulder area, there are two tendons that insert in different areas. The specific anatomy is beyond the scope of this blog but the take home point is that there are two areas of insertion in the area of the shoulder. The muscle extends down the front of the arm to just past the elbow. The reason it crosses the elbow joint is so that it can function to bend the elbow. The bicep in the shoulder area functions to raise the arm out in front, as you would do when reaching for something out of a kitchen cupboard (for example).
Symptoms of bicep tendon injury include local pain (in the front of the shoulder) and pain with movements that use the bicep. There are various conditions that can affect the bicep. These include (but are not limited to) tendinosis, tendonopathy, tendinitis, tear of the bicep tendon or rupture of the bicep tendon. The most common presentation we see in our Burlington clinic is a simple irritation or degeneration of the tendon as it occurs in bicep tendinopathy. This is usually a fairly simple condition for a knowledgeable practitioner to diagnose.
Physiotherapy for Shoulder Pain
X-rays are not usually helpful in diagnosing bicep tendinopathy. Your family doctor may refer you for diagnostic ultrasound to confirm the diagnosis or rule out other causes, but is not always necessary. Interestingly, ultrasound reports often mention fluid around on the head of the bicep tendon. Although this may be less common with other tendon disorders, it is part of the reason our practitioners avoid aggressive manual treatment in this area of the shoulder. Conservative options like laser therapy or acupuncture can be more useful in resolving this area of shoulder pain. Of course, this is a generalization and there are many variables. We recommend that you consult with a knowledgeable practitioner who can diagnose your condition and suggest an appropriate management strategy.
The “take-home” point? Many tendon disorders can benefit from manual treatment like active release and graston. Yet in the case of bicep tendinopathy, you may be best off icing the front of the shoulder and not using aggressive manual therapy. This can perhaps aggravate the area and lead to more inflammation. Perhaps for this area of pain a more “delicate” approach can get you better faster!