By Tim Burkhart, PT
Biceps Muscle Anatomy
Your biceps muscle is located on the front of the upper arm. It is comprised of 2 heads, the long head and short head of the biceps. The biceps is the only muscle to cross two joints: the elbow and shoulder joints. The two heads of the biceps join in the middle of the arm to form a combined muscle belly, working in tandem to bend the forearm. Other functions of the bicep include:
- Aiding the supinator muscle in rotating the forearm upwards.
- Minimally aiding in upper arm movements such as lifting the entire arm forward, lifting the arm to the side, and folding the arm across the body.
Bicep tendonitis is an overuse injury. Any condition with “itis“, at the end of the word means inflammation. In this case, it would be an inflammation of the bicep tendon. This could be either at the upper arm or at the elbow, however rarely does bicep tendonitis occur at two points. Bicep Tendonitis is commonly diagnosed by point tenderness and ruling out other pathologies with imaging such as MRI, X-ray, etc.
Treatment of tendonitis is mostly done conservatively, with physical therapy helping to aid in recovery. The first step is following the RICE principle:
- Rest: just as the name says, giving the inflammation the time it needs to heal by avoiding painful actions of the elbow/shoulder.
- Ice: will help by reducing swelling and inflammation caused by the tendonitis, about three times a day for 10-20 minutes.
- Compression: will also aid in the action of reducing swelling, but will also help immobilize the injured area.
- Elevation: propping the injured elbow above the heart to decrease blood flow to alleviate inflammation.
A doctor may also refer a corticosteroid injection in severe cases of tendonitis without evidence of a tear, to give pain relief and halt the inflammatory process and get the tendon back on the path of healing.
This injury can be partial or complete (torn away from the bone). Tears are often caused by constant overuse, twisting the elbow/shoulder in an awkward way, or falling down on an outstretched arm. At the elbow, tears most often occur during the act of lifting a heavy object.
The most obvious symptom would be a sudden, sharp pain in which you could hear or feel a “pop” when the tendon tears. Other symptoms include:
- A bruise appearing at the shoulder or elbow.
- Feeling of weakness when you try to lift the forearm or upper arm.
- Noticing a change in the contour of the front of your bicep in the upper arm (“Popeye Deformity”).
A doctor can diagnose a bicep tear in a full physical exam, including imaging such as X-ray, MRI, ultrasound, etc…
While people with bicep tears are still able to move their arms reasonably well, there will be a noticeable decrease in upper arm strength. And because of this many of them will elect to proceed with surgical treatment. After surgery, the doctor will prescribe physical therapy, which will follow the doctor’s protocol. It may take 4-6 months for a surgically repaired tendon to completely heal. Watch this VIDEO to learn how to put on and take off your sling at home.
JOI and JOI Rehab
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By: Tim Burkhart, PT and Timothy Hastings, MD