Bicipital Tendinitis

BICIPITAL TENDINITIS

Shoulder pain is the most common condition now a days. there are many reasons for it and every patients are different with there different pain pattern, location, aspect and differential diagnosis.

One of the common reason for shoulder pain is bicipital tendinitis . in this blog will discuss about this topic.

Biceps tendinitis is an inflammation or irritation of the upper portion of the bicep tendon,also called the long head of the bicep tendon. The biceps tendon is a strong,cord-like structure that connects the biceps muscle to the shoulder socket.

Biceps tendinitis can impair patients' ability to perform many routine activities.

• Main function of the biceps muscle is forearm supination and elbow flexion.
• Biceps also contribute 10 percent of the total power in shoulder abduction when the arm is in external rotation

ETIOLOGY

The etiology of biceps tendinopathy can be categorized into primary and secondary cases:

Primary biceps tendinopathy

• Less common, representing about 5% of cases
• Typically seen in young athletes participating in sports like baseball, softball, volleyball, gymnastics,and swimming
• Exact causes are not well understood

Secondary biceps tendinopathy:

• Much more common

• Associated with other shoulder pathologies, including:
   
  • Rotator cuff tendinitis and chronic rotator cuff tendinopathy  
   
  • Subscapularis injuries
   
  • LHB tendon instability/dislocation (seen in association with subscapularis injuries/tears)
   
  • Direct or indirect trauma
   
  • Inflammatory conditions
   
  • Internal impingement of the shoulder (“Thrower’s” shoulder)
   
  • External impingement/Subacromial impingement syndrome
   
  • Glenohumeral arthritis

The condition often develops due to repetitive overhead activities, leading to inflammation

and degeneration of the long head of the biceps tendon as it travels within the bicipital groove of the proximal humerus.

PATHOLOGICAL CHANGES

• In its early stages, the tendon  becomes inflamed and swollen.
• As inflammation progresses, the  tendon and its sheath (covering) can become more irritated, which causes  it to thicken. 
• Occasionally, in the late stages, the damage to the tendon can result in fraying or a complete tear.   A complete tendon tear results in a cosmetic deformity of the arm (a  "Popeye" bulge in the upper arm).

Symptoms

• Pain or tenderness in the front of the shoulder, which worsens with overhead lifting or activity
• Pain with reaching backward, such as to put on your seatbelt in a car or to put a coat on
• Pain or achiness that moves down the upper arm bone
• An occasional snapping sound or sensation in the shoulder

INVESTIGATION:

1. Ultrasonography:

o    Most cost-effective method

o    Good for evaluating isolated tendinopathy extra-articularly

o    Diagnostic criteria include tendon sheath swelling, fluid accumulation, and increased color flow signals

2 Magnetic Resonance Imaging (MRI):

o    Useful for detailed visualization

o    More expensive than ultrasonography

Ultrasonography is generally preferred due to its cost-effectiveness and ability to provide dynamic assessment. However, the choice of imaging may depend on the specific clinical presentation and suspected associated conditions.

TREAMENT:

1.CONSERVATIVE

2.SURGICAL

3.NON-SURGICAL

1.  CONSERVATIVE MANAGEMENT

 Initial treatment should consist of pain management and use of NSAIDs. If this is unsuccessful the use of steroid injections may be helpful in managing pain.  Or for more persistent presentations, corticosteroid injections along the tendon sheath may be indicated. In low-functioning or medically complicated patients, conservative measures should always be pursued initially.

PHYSIOTHERAPY MANAGEMENT

Successful physical therapy regimens target the underlying source(s) contributing to the LHB tendon pathology. Potential factors predisposing to biceps-related shoulder injuries include glenohumeral internal rotation deficit (GIRD) in overhead-throwing athletes/baseball

pitchers,poor trunk control, scapular dyskinesia, and internal impingement.

Physicaltherapy initially focusing on unloading followed by reloading  the effected tendon

• This may start with isometric training if pain is the primary issue progressing into eccentric training and eventually concentric loading as with other forms of tendon rehab.
• Stretching and Strenghening programs  are a common component of most therapy programs. Therapists also use other  modalities, including ultrasound, iontophoresis, deep transverse friction massage, low-level laser therapy, and hyperthermia; however evidence for these modalities are has low quality.
• As a preface to discussion of the goals of treatment during injury rehabilitation, two points must be made:1. Healing tissue must not be over stressed and a very slow heavy loading program should beunder taken. During tissue healing, controlled therapeutic stress is necessary to optimize collagen matrix formation, but too much stress can damage new structures and slow the patient’s rehabilitation The patient must meet specific objectives to progress from one phase of  healing to the next. These objectives may depend on ROM, strength, or activity. It is the responsibility of the physical therapist to establish these guidelines.
• The physical therapist must consider both the patient's subjective response to injury and the physiological mechanisms of tissue healing; both are essential in relation to a patients return to optimal performance.

• Exercise therapy should include:
• 1.  Restoring a pain free range of motion - Pain free range can be achieved with such activities as PROM, Active-Assisted Range of Motion (AAROM), and mobilization via shoulder manual therapy
• 2. Proper scapulo thoracic rhythm. 
• 3. Painful activities such as abduction and overhead activities should be avoided in the early stages of recovery as it can exacerbate symptoms.
• Strengthening program consisting of heavy slowloading should begin wiith emphasison the scapular stabilizers, rotator cuff and biceps tendon.

• Range of 85% cases recover by physiotherapy management .
• Rare of 15% cases may need further management but is can besurgical or nonsurgical option.

Non Surgical treatmen

• At bankers vascular hospital we evaluate our patient first .main aspect is diagnosis and it should be proper.
• At here we have non surgical option for bicipital tendinitis is T.A.M.E. ( transarterial microembolization )
• Chronic inflammation in conditions like tendinitis can lead to the formation of new, During TAE/TAME, a catheter is guided to the specific arteries feeding these abnormal vessels. Tiny particles or temporary agents are then infused into these arteries to block blood flow to the inflamed area. 
  • Pain Reduction: 
  By blocking the blood supply to the pathological tissue andnerve fibers, the inflammation and pain are reduced. Conditions TreatedTAE/TAME is being explored for various chronicand painful musculoskeletal conditions, including:Tendinopathies lik

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abnormally high-volume blood vessels (neovessels) and associated pain-sensing nerves within the tendon. 

• elbow epicondylitis (tennis elbow) and Achilles tendinopathy,Osteoarthritis, Adhesive capsulitis (frozen shoulder), and Plantar fasciitis. Potential Benefits for Bicipital Tendinitis
  • Pain Relief: 
  Studies on other tendinopathies have shown substantial and significant reductions in pain scores after TAE. 
  • Minimally Invasive: 
  Compared to traditional surgery, TAE/TAME is a minimallyinvasive procedure. 
  • Safety: 
  The procedure has been shown to be safe, with few major complications reported in studies.