Bicipital Tendonitis

Treatment For Bicipital Tendonitis

Bicipital tendonitis is quite common in individuals that do a lot of throwing or lifting in their occupation or hobby.  The area between the bicipital tendon and the muscle is extremely vulnerable to repetitive stress injuries.  Body builders that perform a great amount of dips and bench presses, baseball pitchers and individuals that happen to work for deliver companies and are required to lift heavy packages are very susceptible to injury in this area.

Additionally, the elderly are also prime candidates to bicipital tendonitis because the area is weakened with age.  It is quite often confused or mistaken for rotator cuff tendonitis so the patient's work and recreational history will need to be used for a proper diagnosis.  Individuals that have this condition usually will describe their pain as being in the area of the anterior shoulder, often radiating in a downward motion to their elbow.

Levels Of Bicipital Tendonitis

Tendonitis involves an inflammation occurring of the tendon and the paratenon.  They are usually resulted from some type of chronic overload that has lead to tears of microscopic size in the tendon.  These tiny tears then trigger an inflammatory response.  Bicipital tendonitis is divided into four categories that are defined by the occurrence and intensity of pain.

  1. Level One -Pain is present only after participating in activity.
  2. Level Two - Pain is present when activity is started and ended but does not limit the individual from participating in the activity.
  3. Level Three - Pain is present upon beginning the activity and remains there throughout, limiting the level of activity performed.
  4. Level Four - Pain is present all of the time and progresses throughout the day.


Symptoms of bicipital tendonitis are usually alleviated by ice, rest, massage, heat and stretching.  Pain is almost always exacerbated when activity is initiated but will usually lessen as activity is continued.  Individuals will often fight through the pain and it will disappear until activity is ceased.

In the immediate stage of tendonitis, the classic RICE method of rest, ice, compression, elevation should be used.  The offending maneuver that is aggravating the area should be stopped as well.  Mild stretching may be helpful at this point.

If the bicipital tendonitis is in the sub-acute stage then transverse frictions need to be started.  These will release any adhesions from the tendon.  Ultrasound therapy is helpful at this stage to help minimize inflammation and moist heat will facilitate movement.  Very graduate isometric exercises will be recommended to strengthen the tendon slowly without aggravating it or making the condition worse.

With chronic conditions of bicipital tendonitis, the above therapy methods should be performed but a further investigation of the area should take place to check for neurological symptoms or bony abnormalities.

An anesthetic and corticosteroid injection into the tendon may be necessary to reduce pain and inflammation however, this is usually only recommended in severe cases.  In very rare cases, if all treatment methods have failed, surgery may be required to reduce symptoms.  This involves a decompression method using either an open surgical technique or arthroscopic guidance method.


After Surgery

A small range of motion is usually recommended by the surgeon when the time is right.  Therapy begins with electrical stimulation and ice to control swelling and pain.  Massage may also be used to ease muscle spasms in the area.

An exercise routine will be started slowly and then two to four weeks later, heavier bicep exercises will be added to treatment.  As you progress, new exercises will be taught to stabilize and strengthen the joints and muscles in the area.  Therapy may be needed from one to four months after surgery depending on how severe the injury was.