If you’re experiencing pain in the front of your shoulder, you may have an injury to your bicep tendon. The bicep tendon is a relatively common source of shoulder pain. There are variable patient presentations and different treatment options depending on the specific dysfunction. Let’s start with the basics…
Anatomy of the Bicep Tendon
The bicep muscle is the one in your arm that you flex when you’re at the beach. The muscular portion turns into a tendon as it inserts onto the skeleton. There are actually two divisions to the muscle (where the name “bi”-cep comes from). The long head of the biceps is usually the one that is injured. It continues upward into the shoulder and anchors in two places; on a piece of cartilage and on a piece of bone.
Follow the bicep muscle to the shoulder, where the bicep tendon is!
Function of the Bicep
As mentioned above the bicep muscle is well known for its ability to bend the elbow. Its role in shoulder motion and stability is an area of controversy in the world of muculoskeletal medicine, but we do know for certain that the tendon of the bicep (located in the front of the shoulder) has the ability to generate pain.
Pain in the front of the Shoulder
Pain in the bicep tendon is usually located in the front of the shoulder. An easy way to landmark this tendon is to flex your bicep muscle and follow it right up into the top of your shoulder. The top few inches of that line is the vicinity of the bicep tendon. Pain in this area suggests injury to the bicep tendon. According to the literature, there are various causes of bicep tendon injury.
Acute injury to the bicep tendon usually involves a tear. This can occur in the tendon or muscle itself, or more often in the area of the insertion. As mentioned above, the bicep tendon has an insertion on a piece of cartilage called the labrum. For all you baseball fans out there, you’d understand that labrum injuries can be frustrating and stubborn for throwing athletes!
Instability of the Bicep Tendon
Another dysfunction that can affect the bicep tendon is instability. This also commonly affects throwing athletes. Instability of the bicep tendon is when the tendon doesn’t sit in the little groove that it’s supposed to. When the shoulder is moved into certain positions the tendon can “slip out”. This causes pain and irritation.
Bicep Tendinitis / Bicipital Tendinitis / Bicep Tendinopathy
This type of bicep tendon injury is probably the most common type that we see at our clinic. A patient with this type of pain usually has pain in the front of the shoulder and complains of pain with pressure over the area. One explanation for this type of dysfunction is general “wear and tear” on the tendon.
Quite often patients come to our clinic with a diagnostic ultrasound report showing inflammation in the bicep tendon. As mentioned above, wear and tear can be associated with inflammation in the area of the bicep tendon. Conservative treatment can be helpful in this situation. In the situation of acute injuries where the cartilage is thought to be damaged (such as labral tears) an MRI is more useful than diagnostic ultrasound.
Treatment of Bicep Tendon Injuries
Our clinic treats bicep tendon injuries quite often. The treatment approach used often depends on the various factors present in each case. For example, a recent traumatic cartilage injury would likely require referral to an orthopedic surgeon. In the case of the more common degenerative tendinopathy or when your doctor has diagnosed you with bicipital tendinitis, physiotherapy or chiropractic can be helpful. Physiotherapy or chiropractic at our clinic usually involves the use of modalities like laser therapy, interferential current, acupuncture, active release technique, graston technique, other manual therapies and/or rehabilitative exercise.
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Barber A, Field L, Ryu R. Biceps tendon and superior labrum injuries: decision making. The Journal of Bone and Joint Surgery 2007; 89(8): 1843-1855.
Gill HS et al. Physical examination for partial tears of the biceps tendon. American Journal of Sports Medicine 2007; 35(8): 1334-1340.
Krupp RJ, Kevern MA, Gaines MD, Kotara S, Singleton SB. Long head of the biceps tendon pain: differential diagnosis and treatment. Journal of Orthopaedic & Sports Physical Therapy 2009; 39(2): 55-70.