Shoulder - Bicep Tendonitis, Laxity and Rupture
Description
The biceps muscle has two origin points around the shoulder: the long head starts on the glenoid and the short head on the coracoid. The long head is more commonly injured/inflamed as it exits the “ball and socket” joint near the rotator cuff in the front of the shoulder.
What are the causes?
Biceps tendinitis occurs as a result of overuse of the shoulder or from an injury, such as a fall. Because the tendon is closely associated with the rotator cuff, injuries to rotator cuff tendons in the front of the shoulder will place more stress on the biceps, leading to inflammation or injury. It is more common for biceps tendonitis to occur with another injury than by itself.
What are the symptoms?
Biceps tendinitis causes pain in the front of the shoulder, which may radiate into the arm. The biceps may be tender to the touch, especially near the top, front aspect of the shoulder. Raising the arm overhead and towards the front of the body usually increases the pain.
How is it diagnosed?
Your surgeon will perform a thorough history and physical examination that typically includes an X-ray. Your surgeon may perform maneuvers that stress the biceps muscle as well as the rotator cuff to elicit pain. An MRI or ultrasound may be performed to assess the biceps and surrounding rotator cuff muscles for injury.
Non-operative
Non-operative treatment of biceps tendinitis typically starts with physical therapy, anti-inflammatory medication, cryotherapy and avoiding painful activities. An injection can be given into the sheath surrounding the long head of the biceps to reduce inflammation.
Platelet Rich Plasma (PRP) Injections is another non operative option. Blood is taken from your arm and is spun down to get the healthiest healing factors - platelets and serum. Once injected, the platelets degranulate and release activate growth factors and cytokines to promote healing. 1 injection may be all you need, however, there are times where multiple injections may provide additional benefit. Not covered by insurance.
Mesenchymal Stem Cell Injections is another non operative option. Bone marrow is aspirated from your pelvis and centrifuged in a special kit to concentrate the stem cells, which are then reinjected into the bicipital groove. The goals are to change the living microenvironment of the tendon, up regulating collagen formation, and promote tendon cell healing and reorganization. Not covered by insurance.
Operative
In cases which do not improve with non-operative treatment, Dr. Liu may recommend an operation to relieve the pain. Your surgeon can perform a minimally-invasive arthroscopic procedure to evaluate the biceps and surrounding structure. At that time, your surgeon may choose to release the tendon from its attachment at the top of the shoulder socket (biceps tenotomy). This provides pain relief and a quick recovery with no postoperative precautions. Because the tendon has a second attachment on the shoulder blade, there is no loss of function or strength. A cosmetic deformity called “popeye deformity”, may occur as the tendon retracts down the arm.
Alternatively at the time of surgery, your surgeon may reposition the long head of the biceps from its attachment inside the shoulder joint, to a location outside of the joint (biceps tenodesis). This provides pain relief, with no muscle spasm, no cosmetic deformity, and no loss of function.
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