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Tendinitis is also known as tendonitis. This is an inflammation of a tendon, which is a band of fibrous tissue connecting muscle to bone. The inflammation causes pain, tenderness, and occasionally restricted movement of the muscle attached to the tendon.

When we talk about biceps tendonitis, it is an inflammation of the biceps muscle tendon.

What is tendinitis?

Tendinitis can cause permanent damage to the tendons where a natural tendency to favor the painful area can also lead to stiffness. A vague discomfort at the age of 30, if overuse is continued for years, can lead to a loss of flexibility. Most commonly, this is due to scarring of the tissues. Sometimes the discomfort of tendinitis disappears within weeks, especially if you rest the affected area. In elderly people and those who continue to use the affected area, tendinitis often heals more slowly, and could even progresses to a chronic condition. Almost any tendon in the body can be affected. However, those located around the knee, foot, elbow and shoulder are most frequently affected.

Knee tendonitis is a common location for this inflammation type. Actually, there are three types of knee tendonitis – patellar tendinitis, quadriceps tendinitis, and popliteus tendinitis. Patellar tendinitis is also called “jumper’s knee”. It affects the patellar tendon just below the patella (kneecap). The patient complains of pain during an activity such as landing from a jump and going downstairs, or during a lack of activity - for example sitting for long periods of time. Quadriceps tendinitis affects the patellar tendon just above the kneecap; this condition is likely to be found in athletes who do a lot of rapid acceleration and deceleration. Popliteus tendinitis affects the site of insertion of the popliteus tendon on the lateral epicondyle of the femur, so runners, particularly those who run down hills or along sloping surfaces, are likely to complain of this type of tendinitis.

Reducing the symptoms is the first step in alleviating the tendonitis and establishing a diagnosis. The doctor may tell you to use ice or heat, take certain medications, and limit physical activity. This might help control the pain and swelling along with self-massaging the area. Ice helps prevent swelling and reduces pain, so placing ice on the painful area for 10 minutes at a time, several times a day, may be a good idea. If you already have a swelling, heat may help; apply a heating pad or hot towels to the tendon for 30 minutes at a time, two or three times a day. Pain relievers and anti-inflammatory drugs are used to ease immediate symptoms. However, this is not going to cure the condition or keep it from recurring. Injecting cortisone and a local anesthetic into the area surrounding the tendon usually provides substantial relief. However, this relief only lasts for 24-72 hours. In rare cases, surgery is necessary to repair damage. Rest allows the tissues to heal after the surgery. On the other hand, returning to activity too soon may cause the symptoms to reoccur.

Self-massage using a heat-inducing cream or oil may also help with tendonitis. Physical therapists suggest rubbing the ointment in semicircles in all directions away from the knotted tissue three times a day. You should continue with this process until healed.

Shoulder tendinitis has three types, which are rotator cuff tendinitis, calcific tendinitis and biceps tendinitis. The rotator cuff consists of four muscles around the shoulder joint that help control the shoulder’s position. This tendon keeps it stable. With rotator cuff tendinitis the pain is located about three inches below the top of the shoulder. This pain is felt when reaching overhead or behind the back. Rotator cuff tendinitis will usually resolve with rest, anti-inflammatory medications, or an injection of cortisone and a local anesthetic into the area surrounding the tendon. Patients with rotator cuff tendonitis should also exercise using light weights. If pain is not relieved with exercise and medication alone, an x-ray of the shoulder may reveal bony anatomy. This occurs between a bone at the top of the shoulder and the ball at the top of the arm bone. A procedure called an acromioplasty is performed to make more room for the rotator cuff tendons and relieve this problem. Using an arthroscope it is inserted into the shoulder and the surgeon is able to remove some of the bone from the acromion through two or three small 1/4" incisions.

Calcific tendinitis is caused by calcium deposits in the rotator cuff region, and symptoms include excruciating pain and severe restriction of shoulder motion. X-rays reveal calcium deposits within the rotator cuff or overlying the head of the humerus and treatment includes injection of cortisone and a local anesthetic into the area surrounding the tendon. Multiple needle punctures into the calcium deposit may break it up and relieve the symptoms of tendinitis. If conservative treatment is ineffective, arthroscopic calcium removal and subacromial bursectomy are viable alternatives.

Biceps tendinitis is an inflammation of the biceps tendons that attach to the shoulder, usually affecting individuals whose occupations involve repetitive biceps flexion against resistance, or whose activities include forceful throwing of a ball. Biceps tendinitis will resolve with rest, anti-inflammatory medications or an injection of cortisone and a local anesthetic. All this is placed into the area surrounding the tendon, as well as a sling to immobilize the shoulder. With biceps tendinitis surgery is occasionally required to stabilize a displaced tendon.

More on biceps tendinitis

The biceps muscle is a large, strong muscle in the front of the upper arm. This muscle divides into two major sections. The larger section of the bicep, called the long head of the muscle, is connected to the shoulder by a long tendon that passes through a groove in the upper end of the arm bone, called the bicepital groove. That is the point where tendinitis strikes, and beyond the groove, the tendon enters the shoulder joint and attaches to the top of the shoulder socket. Biceps tendon is held in the groove of the upper arm bone by the inter-tubercular ligament. If this ligament is injured or stretched, the tendon slides in the groove causing problems. This is because sliding irritates the tendon, and the result is biceps tendinitis. A second cause of biceps tendinitis may be a deformity in the groove itself that can be too shallow or have rough edges. In any overhead position, the tendon is forced to curve, but the groove is fixed, so if the tendon is not firmly held down, it will slide out.

Signs and symptoms of  biceps tendinitis

Injuries to the biceps tendons are commonly caused by repetitive overhead activity, so symptoms include pain when the arm is overhead or bent. It could also appear as localized tenderness as the tendon passes over the groove in the upper arm bone. Occasionally, a snapping sound or sensation in the shoulder area could also be a sign of biceps tendinitis. If you notice anything similar, it would be good to have doctor’s exam.

Diagnosis and treatment of biceps tendinitis

Like most shoulder ailments, biceps tendinitis is painful, especially in the throwing or serving position. The pain is focused on the front of patient’s shoulder, so for simple cases of biceps tendinitis, it is recommended to apply ice and rest. This means initial treatment is conservative. A patient should also start pendulum exercises as soon as the pain decreases.

Usually, the irritation disappears in a week, but you should know if you put too much pressure on the tendon too soon, the tendinitis will flare up again. For the more severe cases of biceps tendinitis, the doctor could prescribe oral anti-inflammatory medication and two weeks of rest. The icing should continue twice a day and patient should also perform pendulum exercises if they are not too painful. Very rarely does biceps tendinitis require surgery as the only treatment option that works. It only happens when the tendon will not stay in the bicipital groove and the irritation is chronic; the operation procedure involves surgically detaching the tendon from the shoulder joint. It is reattached to the coracoid process, a lip in the front of the shoulder, so this operation alleviates the pain and, almost unbelievably, there is very little loss of strength or mobility.

Surgical options for biceps tendinitis

If the pain results from shoulder instability or from pressure on the tendon from the shoulder bones, your orthopaedist may recommend arthroscopic surgery as the best treatment. Using fiber optic technology and miniature instruments inserted through a small incision, the surgeon can examine the shoulder joint. This way he will also be able to anchor the tendon properly. After surgery, your orthopaedist will prescribe a rehabilitation program. This program includes stretching and strengthening exercises. Early movement is important, but patient should wait for physician’s approval before doing any heavy lifting or returning to sports. However, once diagnosed with biceps tendonitis, the doctor will examine you and see which treatment options is the best choice in your case. Every patient might require different treatment, depending on many variable factors of this disease.

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