Biceps Tendinitis: presentation, evaluation, treatment & rehabilitation

Walker_BicepsTendinitis.pdf

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Background

Epidemiology

Long head of the biceps (LHB) tendonitis is not well reported in the literature despite being common among young, sporting populations (18-35 years). Isolated LHB tendonitis is rare, accounting for only 5% of shoulder cases, attributed to overuse, and most common in throwing athletes, gymnasts, and swimmers. In the general population, it is often secondary to other pathologies, for example, occurring in 85-90% of rotator cuff deficiencies, about 87% of SLAP lesions, synovitis and/or inflammation of the glenohumeral joint capsule, and other labral pathologies. In recent epidemiology reports, isolated LHB tenodesis surgical procedures from 2001 to 2008 has increased 1.8-fold with an overall 1.7-fold increase when including RC involvement, biceps tenosynovitis, biceps tendon rupture, or SLAP lesions. The largest increase of LHB procedures was reported in patients aged 60-69 years (increase in surgeries from 993 to 1752) and 20-29 years (increase in surgeries from 12 to 102).

Contrary to what was though previously, a histologic study shows intra- and extra-articular LHB tendonitis is due to a chronic, degenerative process versus acute and/or chronic inflammation; degeneration in patients was quantified by presence of ground substance (100% of cases), morphologic changes in tenocytes (93% of cases) and collagen bundles (100% of cases), and fibrosis of the tendon (100% of cases). Continued rotational and anterior stress, and subsequent degeneration, can lead to macroscopic delamination and complete rupture of the tendon. During elevation and rotation of the shoulder, the biceps tendon experiences constant sliding within the bicipital groove causing high friction points and an “hourglass” appearance from early hypertrophy.

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