Biceps tendinosis implies degeneration and disorganization of the biceps tendon fibers, typically caused by overuse injuries. The long head of the biceps (one of the two biceps muscles) is most often the affected portion. There is a distal portion of the tendon, near the elbow fold, and a proximal portion of the tendon up by the shoulder. Both parts of the tendon can become tendinopathic or over-worked.
Causes
Biceps tendinopathy is rarely seen in isolation. It is caused by overuse, tendon impingement, shoulder joint instability or trauma. Therefore, it coexists with other pathologies of the shoulder, including rotator cuff impingement syndrome, rotator cuff tears, labral tears, SLAP lesions and shoulder instability. It is common in sports that involve throwing, swimmers, gymnasts and some contact sports. Occupations that involve overhead shoulder work or heavy lifting are at risk.
Symptoms
Pain is seen in the region of the anterior shoulder located over the bicipital groove, occasionally radiating down to the elbow.
Overhead activities usually reproduce pain, especially those positions that combine abduction and external rotation eg cocking to throw.
The pain is often aggravated by shoulder flexion, forearm supination, and/or elbow flexion.
Some patients describe muscle weakness and clicking or snapping with shoulder movements.
Treatment
Procedural options include cortisone injections to the biceps tendon sheath, avoiding the tendon itself. Regenerative-type injections (such as platelet-rich plasma [PRP]) can provide longer lasting pain relief and improved function by stimulating the body’s own natural healing response when conventional treatments have failed.