DR HQ: Anatomy 101— Bicipital Tendinitis

Bicipital Tendinitis is the medical name for biceps tendinitis. The biceps is a muscle in the upper front of the arm. In this edition of Dr. HQ, we’ll focus on the tendon up near the shoulder called the proximal biceps tendon. The distal (meaning away from the body) biceps tendon is down near the upper elbow. While an injury to that area can also be serious, we’ll focus on proximal biceps today.

In the graphic below you can see the biceps muscle in the upper arm. The biceps muscle connects two areas of tendons that connect to the bone in the shoulder region. The short head of the biceps tendon connects to coracoid process. The area we are focusing on is the long head of the biceps that helps connect the biceps muscle to the top of the bones of the shoulder joint. This tendon goes through a ‘canal’ in the anterior (front) of the humerus (upper arm bone) called the bicipital grove to connect to the bone in the shoulder. Note that the labrum in the shoulder capsule is in very close proximity to where this tendon connects to the bone.

courtesy of: http://orthoinfo.aaos.org

Tendinitis and injuries to the biceps tendon

One cause of tendinitis in the long head of the biceps tendon is friction, caused by rubbing/pressure of the tendon running through the canal.

Another potential cause of bicipital tendinitis is an overworked biceps muscle due to weakness in triceps muscle. The triceps muscle is the muscle behind the humerus (upper arm bone). If this muscle has some weakness and isn’t able to ‘pull its weight’ in the pitching motion, it can lead to a strain of the biceps muscle or tendinitis of the long head tendon of the biceps.  This is one reason teams watch the strength of the muscles in the upper arm, as an imbalance can lead to serious problems.

Secondary problems with the pitching shoulder can also contribute to bicipital tendonitis. Impingement syndrome is one of those conditions. This is when the bursa sac or tendons are pinched causing inflammation, pain and a decrease in function. Repetitious activities such overhand throwing of a baseball (or swimming) can also contribute to the impingement. Rotator cuff disease or dysfunction is a worsening of the condition of the rotator cuff to the point where it fails to perform its function. In simple terms, the cuff fails due to tendinitis and muscle weakness. This results in tendons and/or the muscles tearing and failing.

Treatment

Because there are so many factors that can contribute to bicep tendinitis, practitioners treat the inflammation of the tendon along with any muscle weakness, bursitis, damage to the rotator cuff and/or tendons, and even the labrum of the shoulder joint. In a nutshell, treatment can be as minor as a few days rest, oral medication to treat the inflammation, then some shoulder or arm strengthening to get the player (usually a pitcher) back on the mound. At the other extreme, surgery is the last resort in serious cases.

Outlook

As you can see, many of the structures of the throwing shoulder and upper arm are highly inter-related, which makes diagnosing shoulder and upper arm maladies difficult for even the best medical practitioners, let alone fantasy baseball owners. When a player is diagnosed with bicep tendinitis, the best advice is to expect the worst and prepare for further problems down the road, especially if the player does not rebound quickly after the initial diagnosis.

Major League Example

Mike Adams (RHP, PHI) went on the disabled list with bicep tendinitis in late June. Further examination and diagnostic tests revealed he has a lot more damage. Adams has two tears to different sections to the labrum in his right shoulder, plus one to his rotator cuff. Adams, who has a lot of miles on his arm, had a ‘clean’ MRI in December just before the Phillies inked him to a two-year deal. He is now done for this year as he attempts to rehab rather than have surgery. If the rehab doesn’t work, look for Adams to go the surgical route. It also would not be a surprise if he has more damage to the biceps tendon than is being reported. Adams’ situation is a great example how bicep tendinitis signaled wider-ranging problems within the shoulder.


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  For more information about the terms used in this article, see our Glossary Primer.