Shoulder injuries like biceps tendonitis are all too common today. Simply put, biceps tendonitis is inflammation of the tendon that attaches the top of the “long head” of the bicep to the shoulder joint. Some argue that biceps tendonitis is not a proper diagnosis for shoulder pain. In more recent years, doctors and physical therapists are acknowledging the reality of this diagnosis. Most commonly, people report that they feel a majority of their pain in the anterior (front) shoulder. But why exactly does inflammation occur here in the first place?
Biceps Tendonitis is most common in people 18-35-years-old who play sports involving repetitive shoulder motion. Sports like throwing sports, swimming, and gymnastics are quite common.
For other people, the diagnosis can come as a result of tendon overuse. Many of us perform repetitive movements day after day, whether or not we realize it. Repetitive motions like reaching or stretching can take a toll on your shoulder joint over the years.
Diagnosing Biceps Tendonitis Diagnosed
If you experience shoulder pain the first step is to visit a medical professional or physical therapist. In the initial assessment, patients sit with their arm out to the side and asked to rotate their arm in towards them (internal rotation) by 10 degrees. (This is not an extreme rotation.) When in this position, the head of the humerus (the top of the upper arm bone) will sit forward with what’s called the bicipital groove, which is where the biceps tendon sits. In this position, tenderness of the bicep is often felt, resulting in a clear-cut diagnosis.
How is Biceps Tendonitis Treated?
Often, treatments include some sort of anesthetic or corticosteroid that is injected into the biceps tendon sheath, which is the membrane that surrounds the tendon. Many doctors and therapists recommend against injections as they can be dangerous. If the needle were to hit the actual tendon, a possible rupture could occur.
The other treatment for biceps tendonitis is physical therapy. Exercises that strengthen a group of muscles called the rotator cuff (four muscles on your upper back that basically hold your shoulder in its socket) are very helpful in alleviating pain. These exercises include internal and external rotations of the shoulder, often using a cable and pulley system, but can be performed with free weights as well.
These muscles are often weak due to common activities such as slouching, sitting at the computer, and poor posture, particularly for extended periods of time.
Other exercises include ones that work flexion of the arm (curling your arm towards you) and extension (straightening your arm to make it 90 degrees) with some sort of resistance, such as a dumbbell. These are all completed for a set amount of reps, sets, and time.
Lastly, stretching should be included with these exercises. This will help in the loosening of the tendon, because it is very tight in the front of the shoulder and most likely quite weak and loose in the posterior (back) of the shoulder.
The Common Problem with Biceps Tendonitis Treatment
Very few problems occur when supervised by a physical therapist. The therapist is there to monitor patients and assist in that learning curve when learning the “feel” of these exercises and stretches. Potential problems arise when patients perform the exercises and stretch at home, where they are unsupervised.
During this time, they may forget how to properly perform the given task. In the case of home-based therapy results may decline significantly. Fortunately, there is a way to address this problem.
Electromyography (EMG) is a great solution for someone diagnosed with this problem. When using EMG, an electrode is placed on a muscle to examine how much the muscle is contracting. This is illustrated in wavelengths shown on a screen, which looks like this:
The higher the wave, the more the person is contracting their muscles. It’s that simple.
In the case of Biceps Tendonitis, EMG biofeedback monitors muscles and muscle systems for muscle activation and proper use. When performing a common lateral raise exercise (raising your arm to the side with a weight in hand), the upper trapezius (shown below in orange) activates to assist in the movement. This takes much of the shoulder and bicep out of the movement, limiting this exercises’ therapeutic capabilities.
Place an electrode directly on the upper trapezius muscle to monitor activity while performing the exercise. The goal would be to see as little activity as possible coming from this muscle to make sure it’is performed correctly.
EMG and Biceps Tendonitis
In the past, EMG posed too many barriers for most patients. In most cases, this type of technology is very expensive (costing upwards of $40,000) and requires bulky equipment and software. However, recent technological advances mean that EMG devices are getting cheaper and smaller.
For people recovering from Biceps Tendonitis, they can now acquire this technology right on a phone or tablet. An easy-to-use interface shows patients how strongly the given muscle is tensing. This is a lot more convenient than having to lug around a computer and wired electrodes with you.
The Resility system gives the physical therapist the ability to help patients understand their muscles and what goals they are working on. Using the threshold feature shows patients what muscles they are using during home therapy.
You can use EMG inside and outside of the physical therapy clinic. This gives therapists a better look at how their patients are progressing with their home exercises. It simultaneously educates patients on how to properly train their bodies for better recovery and optimal functioning. So, EMG is becoming an important tool for physical therapists and their patients to manage pain, including Biceps Tendonitis.
- Patton, W. C., & Mccluskey, G. M. (2001). Biceps Tendinitis And Subluxation. Clinics in Sports Medicine, 20(3), 505-529. doi:10.1016/s0278-5919(05)70266-0
- Fitzpatrick, D., & Menashe, L. (2018). Magnetic Resonance Imaging Evaluation of the Distal Biceps Tendon. The American Journal of Orthopedics, 47(5). doi:10.12788/ajo.2018.0037
About the Author
Zachary MacDonald is an assistant researcher in the Human Performance Lab at The University of Tampa. He holds a Masters’ Degree in Exercise and Nutrition Science from this very institution and is an expert in the fields of sports nutrition and supplementation.
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