A long head of biceps tendinopathy is a common reason for pain at the front of the shoulder in athletes, people who attend the gym and clients who have an osteoarthritic shoulder, rotator cuff injury and/or subacromial bursitis. The word tendinopathy refers to the condition where a tendon thickens and becomes less stretchy, and in this case we are referring to a thickening of the tendon of your biceps brachii muscle. Anatomically speaking the long head of biceps sits in the bicipital groove of your humerus and enters the shoulder joint over the humerus to insert into the shoulder socket (also known as the glenoid). The bicep muscle complex functions to primarily to bend the elbow, whereas the upper part of the biceps more specifically pulls the arm away from the body in shoulder flexion and inwardly rotates the arm. This injury is one of a lesser seen injury occurring to around 5% of shoulder conditions, however it often presents in younger athletes who participate in baseball, volleyball, gymnastics or swimming.
Common signs and symptoms of a long head of biceps tendinopathy can include anterior and/or front of shoulder pain, pain with overhead activities or pain radiating down the front of the arm. Some people can also experience a clicking or popping sound with shoulder movement. A proper physical examination by a Physiotherapist is required for diagnosis as it can closely present like an acromioclavicular joint (AC joint) pathology, adhesive capsulitis/ frozen shoulder, cervical spine pathology, glenohumeral osteoarthritis, rotator cuff tear and/or a SLAP lesion.
Physiotherapy treatment for a long head of biceps tendinopathy utilises a period of acute unloading followed by appropriate reloading of the tendon. Initially, a short course of NSAID’s (anti-inflammatory medication), ice and load modification (ie removing aggravating factors such as overhead activities) is undertaken to reduce the pain levels. At this point we often spend considerable time understanding the stage of tendinopathy you are currently within, as well as explaining the specific exercise rehabilitation related to achieving the goal of thinning the long head of bicep tendon once more. Once the pain has begun to settle pain free exercises and stretches are prescribed related to the amount of thickening of the tendon and whether there are any concurrent shoulder conditions present. Stretches assist regaining range of motion while specific exercises help with improving strength around the shoulder. Physiotherapist can also use manual therapy in this timeframe for tissue healing if appropriate.
In some case cortisone injections into the direct area may be considered along with surgical consideration if conservative management is not effective.
Have you been pushing through shoulder pain for too long? Go on, book yourself to see an OHL Physiotherapist today to get a proper assessment and get yourself on the way to feeling better soon. You can book to see us via the Client Portal on our website, or you can call us on 9431 5955.