Biceps Tendon Tendinitis (Proximal) and Tenosynovitis

with Rehab

ExitCare ImageTendonitis and tenosynovitis involve inflammation of the tendon and the tendon lining (sheath). The proximal biceps tendon is vulnerable to tendonitis and tenosynovitis, which causes pain and discomfort in the front of the shoulder and upper arm. The tendon lining secretes a fluid that helps lubricate the tendon, allowing for proper function without pain. When the tendon and its lining become inflamed, the tendon can no longer glide smoothly, causing pain. The proximal biceps tendon connects the biceps muscle to two bones of the shoulder. It is important for proper function of the elbow and turning the palm upward (supination) using the wrist.

Proximal biceps tendon tendinitis may include a grade 1 or 2 strain of the tendon. Grade 1 strains involve a slight pull of the tendon without signs of tearing and no observed tendon lengthening. There is also no loss of strength. Grade 2 strains involve small tears in the tendon fibers. The tendon or muscle is stretched and strength is usually decreased.

SYMPTOMS

  • Pain, tenderness, swelling, warmth, or redness over the front of the shoulder.

  • Pain that gets worse with shoulder and elbow use, especially against resistance.

  • Limited motion of the shoulder or elbow.

  • Crackling sound (crepitation) when the tendon or shoulder is moved or touched.

CAUSES

The symptoms of biceps tendonitis are due to inflammation of the tendon. Inflammation may be caused by:

  • Strain from sudden increase in amount or intensity of activity.

  • Direct blow or injury to the elbow (uncommon).

  • Overuse or repetitive elbow bending or wrist rotation, particularly when turning the palm up, or with elbow hyperextension.

RISK INCREASES WITH:

  • Sports that involve contact or overhead arm activity (throwing sports, gymnastics, weightlifting, bodybuilding, rock climbing).

  • Heavy labor.

  • Poor strength and flexibility.

  • Failure to warm up properly before activity.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow time for recovery between activities.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper exercise technique.

PROGNOSIS

With proper treatment, proximal biceps tendon tendonitis and tenosynovitis is usually curable within 6 weeks. Healing is usually quicker if the cause was a direct blow, not overuse.

RELATED COMPLICATIONS

  • Longer healing time if not properly treated or if not given enough time to heal.

  • Chronically inflamed tendon that causes persistent pain with activity, that may progress to constant pain and potentially rupture of the tendon.

  • Recurring symptoms, especially if activity is resumed too soon or with overuse, a direct blow, or use of poor exercise technique.

TREATMENT

Treatment first involves ice and medicine, to reduce pain and inflammation. It is helpful to modify activities that cause pain, to reduce the chances of causing the condition to get worse. Strengthening and stretching exercises should be performed to promote proper use of the muscles of the shoulder. These exercises may be performed at home or with a therapist. Other treatments may be given such as ultrasound or heat therapy. A corticosteroid injection may be recommended to help reduce inflammation of the tendon lining. Surgery is usually not necessary. Sometimes, if symptoms last for greater than 6 months, surgery will be advised to detach the tendon and re-insert it into the arm bone. Surgery to correct other shoulder problems that may be contributing to tendinitis may be advised before surgery for the tendinitis itself.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Corticosteroid injections may be given. These injections should only be used on the most severe cases, as one can only receive a limited number of them.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND EXERCISES - Biceps Tendon (Proximal) and Tenosynovitis

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may go away with or without further involvement from your physician, physical therapist, or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image STRETCH – Flexion, Standing

  • Stand with good posture. With an underhand grip on your right / left hand and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm in front of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Try to avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine. Hold for __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Abduction, Supine

  • Lie on your back. With an underhand grip on your right / left hand and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm out to the side of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Try to avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine. Hold for __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image ROM – Flexion, Active-Assisted

  • Lie on your back. You may bend your knees for comfort.

  • Grasp a broomstick or cane so your hands are about shoulder width apart. Your right / left hand should grip the end of the stick so that your hand is positioned "thumbs-up," as if you were about to shake hands.

  • Using your healthy arm to lead, raise your right / left arm overhead until you feel a gentle stretch in your shoulder. Hold for __________ seconds.

  • Use the stick to assist in returning your right / left arm to its starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Flexion, Standing

  • Stand facing a wall. Walk your right / left fingers up the wall until you feel a moderate stretch in your shoulder. As your hand gets higher, you may need to step closer to the wall or use a door frame to walk through.

  • Try to avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine.

  • Hold for __________ seconds. Use your other hand, if needed, to ease out of the stretch and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image ROM - Internal Rotation

  • Using underhand grips, grasp a stick behind your back with both hands.

  • While standing upright with good posture, slide the stick up your back until you feel a mild stretch in the front of your shoulder.

  • Hold for __________ seconds. Slowly return to your starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH - Internal Rotation

  • Place your right / left hand behind your back, palm-up.

  • Throw a towel or belt over your opposite shoulder. Grasp the towel with your right / left hand.

  • While keeping an upright posture, gently pull up on the towel until you feel a stretch in the front of your right / left shoulder.

  • Avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine.

  • Hold for __________ seconds. Release the stretch by lowering your opposite hand.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Biceps Tendon Tendinitis (Proximal) and Tenosynovitis

These exercises may help you regain your strength after your physician has discontinued your restraint in a cast or brace. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does get worse, stop and make sure you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your caregiver.

ExitCare Image STRENGTH - Elbow Flexors, Isometric

  • Stand or sit upright on a firm surface. Place your right / left arm so that your hand is palm-up and at the height of your waist.

  • Place your opposite hand on top of your forearm. Gently push down as your right / left arm resists. Push as hard as you can with both arms, without causing any pain or movement at your right / left elbow. Hold this stationary position for __________ seconds.

  • Gradually release the tension in both arms. Allow your muscles to relax completely before repeating.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Shoulder Flexion, Isometric

  • With good posture and facing a wall, stand or sit about 4-6 inches away.

  • Keeping your right / left elbow straight, gently press the top of your fist into the wall. Increase the pressure gradually until you are pressing as hard as you can, without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold for __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you start the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Elbow Flexors, Supinated

  • With good posture, stand or sit on a firm chair without armrests. Allow your right / left arm to rest at your side with your palm facing forward.

  • Holding a __________ weight, or gripping a rubber exercise band or tubing,

  • bring your hand toward your shoulder.

  • Allow your muscles to control the resistance as your hand returns to your side.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Shoulder Flexion

  • Stand or sit with good posture. Grasp a __________ weight, or an exercise band or tubing, so that your hand is "thumbs-up," like when you shake hands.

  • Slowly lift your right / left arm as far as you can, without increasing any shoulder pain. At first, many people can only raise their hand to shoulder height.

  • Avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine.

  • Hold for __________ seconds. Control the descent of your hand as you slowly return to your starting position.

Repeat __________ times. Complete this exercise __________ times per day.