Pain In Bicep And Shoulder

Pain Around The Upper Arm And Shoulder

This happens when the pain is localized predominantly in the area of your shoulder and upper part of your humerus. The conditions that cause this can include:

• Rotator cuff disease: Initially, pain is often felt at the front of the shoulder.
• Torn rotator cuff: Tears in the rotator cuff can include pain that begins near the shoulder.
• Dislocated shoulder: Pain from a shoulder dislocation is most acutely felt near the shoulder.
• Broken collarbone: The pain from a broken collarbone can be felt close to the shoulder, particularly when you try to move your arm.
• Frozen shoulder: This type of pain typically comes on gradually and feels dull and deep.
• Calcific tendinitis: Pain due to calcific tendinitis can be severe and can come on suddenly, often in the morning.
• Shoulder sprain: You can feel pain from a shoulder sprain not only in your shoulder, but also in the area of your upper arm and collarbone.
• The pain due to a separated shoulder is felt around the shoulder and upper arm.
• Shoulder osteoarthritis and RA: People with arthritis in their shoulder often feel a deep ache in their shoulder and upper arm.
• Brachial neuritis: Pain from brachial neuritis is typically severe and most often happens in the area of the shoulder and upper arm.
• Brachial plexus injury: Pain from a brachial plexus injury can happen around the shoulder and upper arm. It may be long lasting.

Understanding Bicep Tendonitis And When To Visit A Doctor

If you are experiencing pain or weakness in your shoulder there are multiple reasons why this might occur. The possibilities range from a sprain or strain to arthritis, bursitis, frozen shoulder, and swimmers shoulder. Shoulder discomfort can also emerge due to a rotator cuff issue, a broken collarbone, broken arm or separated shoulder.

One other potential issue that can create pain or weakness is biceps tendonitis. This condition is an inflammation of the upper biceps tendon.

How Is The Cause Diagnosed

Because there are many possible causes for chest and shoulder pain, diagnosis can be challenging.

Your doctor will take a full medical history to find out about any other health conditions you may have. Theyll also ask if your family members have heart disease or other types of conditions.

Your doctor will ask about your symptoms, when they started, how long they lasted, and if they changed.

Once your doctor knows more about your symptoms and any other health conditions, theyll do a physical exam and listen to your heart and lungs.

There are many diagnostic tests your doctor may use to determine whats causing your shoulder and chest pain. Common diagnostic tests include:

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A Lack Of Shoulder Internal Rotation

One of the main – and most underrated underlying causes of bicep tendon pain is a lack of shoulder internal rotation.

For those unaware, shoulder internal rotation is basically the ability to turn your palm down with your arm outstretched and also reach behind your back.

Shoulder rotation is important as it allows the shoulder girdle to remain in a strong, stable posture – making use of all surrounding musculature. With reduced shoulder, internal rotation itâs much harder to keep your shoulder back in a good position when using it.

As a result, it becomes easy for the shoulder to “dump” forward and increase the load on the biceps tendon.

As you can see from the image above, this manâs shoulder subtly tilts forward as opposed to sitting straight up and down. In both the middle and far-right images, you can actually see the tip of his humerus/shoulder sitting forward. And as soon as that shoulder wants to tilt forward the bicep tendon gets included more in the conversation.

It’s vitally important that you be able to recognize how your shoulder sits at rest. Because its virtually impossible to pick this up while moving.

So with this in mind, stop reading this article for just a minute and go find a mirror. Turn side-on and see how your shoulder is positioned.

Does your arm sit vertically with your shoulder back? Or does your shoulder tilt forward?

If it does, you may have just witnessed one of the main, hidden causes of your biceps tendon pain.

Causes Of Biceps Tendonitis

Biceps tendonitis is inflammation of the tendon of the biceps muscle, which is the large muscle on the front of the upper arm that is used to bend the elbow. The biceps muscle splits into two muscle heads that attach to different bones in the shoulder region via fibrous cord-like structures known as tendons. When these tendons become inflamed through a variety of causes, it can cause pain in the shoulder. This can occur due to injury or dysfunction as well as impact or trauma.

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Proximal Biceps Tendon Problems

Most proximal biceps tendon problems occur on the long head of the biceps. The short head of the biceps is farther away from the shoulder joint and has a solid attachment to the bone.

The long head of the biceps courses through a groove in the arm bone, then through the rotator cuff and attaches to the bone near the labrum of the shoulder. The long head of the biceps can have problems at any of these locations.

Most problems of the long head of the biceps cause pain over the front of the shoulder often people feel a snapping or clicking sensation. In addition, biceps tendon problems are commonly associated with rotator cuff problems, so in many cases, both of these problems need to be treated together.

Common long head of the biceps tendon problems include:

Tips To Prevent Biceps Tendonitis

While some injuries are inevitable, simple changes can reduce the risk of biceps tendonitis:

• Strengthen your upper back: Think of a crane if the base of the crane is strong, the arm of the crane will be strong. Its the same with your back, shoulder, and arms.

• Stretch before activity: Warm tendons and muscles are more flexible and less likely to be damaged.
• Change up your activities: If you are a one-sport athlete, incorporate other forms of exercise into your training. Cross-training builds whole-body strength and reduces the risk of overuse injuries. Talk with your doctor and employer if you are concerned about the volume repetitive movements you perform at work.
• Mind your form and posture: Establish proper mechanics for movement, such as throwing a baseball or lifting over your head. Practicing good posture throughout the day reduces unnecessary strain on your tendons.
• Quit smoking: And avoid secondhand smoke, which also reduces your bodys ability to avoid tendon injury and heal inflammation.

Many patients with tendonitis respond well to rest, anti-inflammatory medication such as ibuprofen, and/or physical therapy. If these conservative treatments dont work, ask your doctor whether biceps tenodesis might be an appropriate option.

To discuss your shoulder pain with one of our orthopedic surgeons, call orrequest an appointment online.

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Torn Biceps Tendon Treatment

Most biceps tendon tears involve the long head close to the shoulder joint. Most cases of a torn long head of biceps tendon present with sudden pain, swelling, and bruising in the upper part of the biceps muscle. Sometimes, the biceps muscle bunches up and looks like a popeye muscle.

We avoid operating on these common ruptures because pain and function are not significantly changed. However, we operate on biceps tendon ruptures near the elbow joint.

What Is Biceps Tendinitis

Tendinitis is a condition in which inflammation accumulates at a tendon, causing pain. The biceps tendon, the tendon associated with the biceps muscle, is made up of 2 parts: the long head and the short head. The long head of the biceps is most commonly affected by tendinitis, as the tendon from the muscle runs up the length of the arm and attaches to the labrum and the shoulder blade in the shoulder joint.

Biceps tendinitis results when excessive, abnormal forces are applied across the tendon, including tension , compression , or shearing . When the tendon is subjected to repetitive stresses, it can become irritated, swollen, and painful.

There are many factors that may lead to biceps tendinitis, including:

• Activities requiring repetitive overhead movement of the arms, such as placing dishes in a high cupboard or lifting boxes above the head.

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Recovery From Bicep Tear Or Strain

The time needed to recover from a bicep tear or strain will depend on many factors, including age and health of patient, as well as severity of the injury. Mild injuries take ten weeks or more, while more severe injuries that require surgery can take months to fully recover function.

Your physical therapist and orthopedic surgeon will require you to wear a sling for four weeks following surgery and gradually build up your strengthening exercises as you get stronger. Physical therapy will be crucial to strengthening the muscles to allow you to return to your day-to-day activities.

During the recovery process, avoid participating in activities that cause pain .

What Are Biceps Tendon Tears

In cases of serious or constant overuse, a tendon may fray and eventually tear. A tendon can also tear as part of an injury, such as moving or twisting your elbow or shoulder in an awkward way, or falling down with your arm outstretched. At the elbow, the bicep tendon most often tears during the act of lifting a heavy object .

A biceps tendon tear can happen at either the shoulder or the elbow. A tear can also be complete or partial. A complete tear means the tendon has torn away from the bone.

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How Long Is Rehabilitation After Rotator Cuff Repair

Rehabilitation usually begins the first week after arthroscopic surgery or an open rotator cuff repair. It is very important to follow the program that the surgeon recommends. The physical therapist will demonstrate how to do the exercises to increase range of motion and to build muscle strength. A typical program might start with stretching and some minor strengthening exercises with rubber bands and light weights. It might take up to several months before strength is back to normal, but with hard work and adherence to the recommended program, in most cases a full recovery is likely.

Treatment For Biceps Tendonitis

Treatment for biceps tendonitis begins with resting the shoulder whenever possible and taking over-the-counter anti-inflammatory medicines like Advil or Aleve. Physical therapy may be recommended to both stretch and strengthen the shoulder and affected areas.

If the symptoms do not improve with conservative treatment, or if there are other underlying conditions, it may be necessary to have surgery to correct biceps tendonitis.

If you are experiencing shoulder pain and symptoms of bicep tendonitis, contact us to schedule an appointmentwith one of our physicians in Walnut Creek, San Ramon, Brentwood, and Concord.

• I have an incredible Surgeon– Bob Donaldson

• Partial Knee Replacement– KMC, Patient

• They were very fast to get us in and incredibly personable, knowledgeable, kind, and wonderful with my son.– T.M.

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More On Cortisone Shot For Biceps Tendonitis

Generally, we target the biceps tendon sheath containing the long head of the biceps. The needle is placed carefully in the sheath using ultrasound guidance. It is important not to inject the tendon structure with cortisone due to the risk of rupture.

Evidence suggests that injecting the biceps tendon sheath with ultrasound guidance improves accuracy and effectiveness. Also, side effects are reduced. So, all in all, we should use ultrasound guidance for biceps tendon sheath injections.

What You Need To Know

• Rotator cuff tendinitis may also be referred to as shoulder bursitis, shoulder impingement or biceps tendinitis.
• Symptoms of rotator cuff tendinitis include pain and swelling in the shoulder area, limited motion or weakness of the arm.
• Rotator cuff tendinitis usually occurs over time after repeated stress on the rotator cuff.
• If left untreated, rotator cuff tendinitis can worsen and lead to a partially or completely torn tendon.
• Surgery is rarely used to treat rotator cuff tendinitis unless the rotator cuff is severely damaged or torn.

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Sudden Force Applied To The Arm Or Shoulder

This includes actions in sports or work and can injure the biceps tendon and lead to biceps tendonitis. Specific actions may be more likely to result in injury to the biceps tendon. Types of actions associated with biceps tendonitis include lowering the body during a pull-up, catching a heavy object that falls suddenly, shoveling heavy snow, or forcibly extending the arm when the elbow is flexed.

What Are The Stages Of Rotator Cuff Injury

The first warning sign of cuff injury is pain and swelling of the bursa, as described above. Shoulder weakness and/or limited range of motion can also occur with long-term irritation or outright injury to the shoulder. The tendinitis can progress to a partial or complete tear of a tendon due to progressive weakening of the fibers.

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Orthopedic Associates Can Help With Your Shoulder Conditions

It is clear that having your shoulder functioning properly is of vital importance. Fortunately, the professionals at Orthopedic Associates are ready to provide you with their expertise whenever you or someone in your family is contending with a biceps or shoulder issue, or from any type of condition. Our collection of board-certified doctors supply the vast knowledge that can only result from a combined 183 years of experience. This is beneficial in their ability to design effective treatment plans that will guide you back to a pain-free existence.

The specialists at Orthopedic Associates are also dedicated to helping you with a large range of shoulder conditions:

• Acromioclavicular Joint Arthritis
• Calcific Tendinitis of the Shoulder
• Calcific Tendinitis of the Shoulder
• Fracture of the Collarbone
• Fracture of the Shoulder Socket
• Fractures of the Greater Tuberosity
• Fractures of the Shoulder Blade
• Frozen Shoulder
• Muscle Imbalance in the Shoulder
• Muscle Strain of the Upper Back
• Osteoarthritis of the Shoulder
• Proximal Humerus Fracture
• Rheumatoid Arthritis of the Shoulder
• Rotator Cuff Injuries/Tears
• Snapping Scapula Syndrome

Wear And Tear Of Your Shoulder: No Gain Just Pain

The shoulder is one of the most complex joints in the body and is susceptible to wear and tear just like the hips. Johns Hopkins shoulder surgeon Dr. Uma Srikumaran discusses some of the most common shoulder conditions associated with everyday wear and tear, including their symptoms and treatments.

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Treatment Of Long Head Of Biceps Tendonitis

In general, treatment depends on the pathology.

For the long head of biceps tendonitis, simple treatments including ice, anti-inflammatory tablets, and physiotherapy are effective. Examples of exercises that can help biceps tendonitis include wall push-ups, single-arm rows, single-arm reverse flys, and prone planks. These exercises should be used in combination with general rotator cuff strengthening.

In more severe cases, injection therapy can help. Some doctors use cortisone directed to the groove containing the inflamed biceps tendon. Cortisone reduces tendon inflammation and pain but may lead to rupture. Other doctors use hyaluronic acid or PRP. It is essential to use ultrasound as evidence suggests improved accuracy and effectiveness compared to blind injections.

For biceps subluxation or dislocation, we suggest surgery. First, surgeons can cut the tendon, also called a tenotomy. Alternatively, they can cut the tendon and reattach it to the bone. Therefore, the muscle retains its function, but the shoulder problem resolves. Surgeons call this procedure tenodesis. Studies suggest there is very little difference in outcomes between these two procedures.

How Is It Diagnosed

When you first go to see your physical therapist, the therapist will review your medical history, ask you to describe your shoulder condition, and perform a comprehensive physical exam of your shoulder and upper trunk. Your physical therapist will assess different measures, such as sensation, motion, strength, and flexibility, and may ask you to briefly perform the activities that cause your pain.

Your physical therapist will likely touch various areas on your shoulder to see which seem to be most consistently painful. Other nearby areas, such as your neck and upper back, also will be examined to determine whether they might be contributing to your shoulder pain.

Imaging techniques, such as an X-ray or MRI, are typically not needed to diagnose biceps tendinitis. However, in the event that your physical therapist suspects there are other conditions present in your shoulder, you may be referred to an orthopedist for further investigation.

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Crafting A Ship In A Bottleor Shoulder

With the distinct boundaries of the shoulder and narrow surgical incision sites, performing arthroscopic tenodesis is like crafting on a ship in a bottle. Rather than opening the arm and shoulder with 3-5cm incision, I make four tiny keyholes to access the damaged tendon.

Using an arthroscope a lighted, flexible tube affixed with a camera and advanced imaging displays, I navigate through the upper arm and shoulder. Then, I use miniature surgical tools to detach the tendon from the glenoid labrum, which is the shallow socket area in which the ball of the shoulder joint rests. If necessary, I remove the damaged portion of the tendon.

Then I drill an 8mm hole in the humerus, the bone that runs from the shoulder to the elbow, and attach a tendon anchor into the shoulder bone. Affixing the tendon to the anchor essentially gives it a new home without the problematic 90-degree turn. Then, we remove the arthroscope and tools and close the keyhole incisions. The procedure takes 1-2 hours, and most patients can go home the same day.

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