Biceps Tendinitis

• Biceps tendinitis can develop due to overuse or repetitive stress on the biceps tendon, particularly in activities that involve repetitive overhead motions or lifting.
• Degenerative changes associated with aging or wear and tear on the shoulder joint can lead to fraying or irritation of the biceps tendon.
• Shoulder impingement syndrome, where the biceps tendon becomes pinched or compressed within the shoulder joint, can also contribute to the development of biceps tendinitis.

• Patients with biceps tendinitis may experience anterior shoulder pain, particularly with overhead activities or movements that involve flexing the biceps muscle.
• Tenderness over the bicipital groove, located in the front of the shoulder, may be present upon palpation.
• Weakness in shoulder flexion or elbow flexion, as well as snapping or popping sensations in the shoulder joint, may also occur.
• Pain and discomfort may worsen with activities that place strain on the biceps tendon, such as lifting heavy objects or reaching overhead.

• Diagnosis of biceps tendinitis involves a thorough physical examination, including palpation of the bicipital groove, assessment of shoulder range of motion, and provocative tests to reproduce symptoms.
• Imaging studies, such as MRI or ultrasound, may be ordered to visualize the biceps tendon and assess for signs of inflammation, tendon degeneration, or associated shoulder pathology.
• Diagnostic injections, such as a biceps tendon sheath injection with local anesthetic and corticosteroid, can help localize pain and confirm the diagnosis.

Conservative Management:

• Non-operative treatment may be considered as first-line therapy for patients with mild to moderate biceps tendinitis.
• Conservative measures may include rest, activity modification, ice therapy, anti-inflammatory medications, and physical therapy to alleviate pain and inflammation, improve shoulder mechanics, and strengthen the rotator cuff and scapular stabilizers.
• Corticosteroid injections may be used judiciously to provide short-term relief of symptoms, although caution is advised due to the risk of tendon weakening with repeated injections.

Biceps Tenodesis:

• Surgical intervention with biceps tenodesis may be indicated for patients with refractory biceps tendinitis, SLAP tears with concomitant biceps pathology, or cosmetic concerns related to a “Popeye” deformity.
• Biceps tenodesis involves releasing the biceps tendon from its original attachment and reattaching it to a stable anchoring point, typically the humerus or the glenoid, to relieve pain and improve shoulder function.
• The surgical technique may involve open or arthroscopic approaches, with variations in the location of the tenodesis site and fixation methods.
• Postoperative rehabilitation aims to protect the tenodesis site, restore shoulder range of motion and strength, and gradually return to functional activities, with an emphasis on avoiding activities that place excessive stress on the biceps tendon.