Today’s guest post by Dr. Michael Infantino of RehabRenegade.com covers an often glossed over culprit of shoulder pain….the bicep tendon.

It can be an annoying area to treat/work around and when not addressed can derail anyone’s training for a long time.

However, an injury with the bicep tendon isn’t always as tumultuous as it may seem, and sometimes can be tackled with some simple fixes. 

Enjoy.

 

Bicep Tendonitis? When In Doubt Check These 5 Muscles Out

Knowledge and wisdom are not one in the same. A profound statement for an article that is going to discuss pain at the plain old bicep tendon. The reason I bring this up is because an endless amount of information is available to you through the internet.

When you search bicep tendon pain you will likely run into 100,000 articles that talk about pain local to the bicep tendon. I could make an argument that less than 1% will discuss techniques that you can implement to independently resolve your pain.

That is our plan for today.

Before we start drawing up a six week rehabilitation plan for your shoulder or sending you to the nearest orthopedic surgeon, lets attempt some quick fixes. Please, do not mistake a quick fix with a half-hearted attempt.

Refrain from replacing the whole roof when a few shingles will do.

Step one is making sure you are an appropriate candidate for this article. Let’s rule out a bicep tendon rupture!

Schedule an appointment immediately with an Orthopedic Physician if:

1. You heard a sudden “ pop” at the shoulder, along with swelling and bruising around the bicep.

This typically occurs when you are trying to “man up” and carry something that is a tad bit too heavy for you. Often a result of your best friend refusing to pay for a moving company.

2. You have a nice “Popeye” deformity at the bicep.

This doesn’t imply that you have impressive biceps. It means you tore the bicep tendon.

Other Reasons For Concern:

Weakness and pain local to the bicep when flexing the bicep or rotating your palm up to the sky with the elbow partially bent. This does not indicate a rupture, but a partial tear is still possible.

I don’t think I tore my bicep tendon. What else could cause irritation to the bicep tendon?

It is common for the bicep tendon to be a pain generator because of its location. The bicep tendon is often impinged between the humerus and surrounding structures in the shoulder (usually the acromion and the coracoid process).

Keep in mind that impingement is normal.

We have nice “cushions” named bursae that are built to tolerate this compression. It is when this compression becomes too frequent or too intense that we see injury occur at the bicep tendon. We tend to see this in people who perform a lot of overhead activities in athletics or with work requirements.

It hurts when I rub my fingers across the bicep tendon. Doesn’t this mean it is a bicep tendon problem?

Simply rubbing your finger across the bicep tendon is not an accurate way to diagnose a bicep tendon injury. This is the most common mistake I see by medical providers and those with a certification in WebMD browsing. This is not a specific or sensitive test for diagnosing a bicep tendon injury. (Gill, HS)

What is the best way to determine if the bicep tendon sustained an injury?

The gold standard would be an ultrasound from a physician (Skendzel, JG). Isolating the bicep is the next best method. Resistance to the bicep, or lowering yourself in a reverse grip pull up is also useful information.

It is possible that you have developed some inflammation local to the bicep tendon. Most of the special tests specific to the bicep do not have great statistics. We can make a more accurate diagnosis by considering how you sustained your injury and the movements that provoke your pain.

Could pain at the front of my shoulder be related to something else besides the bicep tendon?

Absolutely. Muscles throughout the shoulder and neck can refer pain to the front of the shoulder. The same way that organs can refer pain to different regions of the body.

Let’s check out 5 muscles that commonly refer pain to the front of the shoulder.

 

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Deltoid

People often forget that the muscle fibers of the deltoid run over the bicep tendon. When you feel pain while pressing around the bicep tendon it may actually be an irritated deltoid.

Biceps

Another no brainer if you are having pain around the bicep tendon. Overuse of the biceps or a quick force applied to the biceps (eccentric force) can cause trigger points to develop in this muscle. If you notice increased discomfort around the bicep some soft tissue work and a few days off from the “gun show” should help.

Pectorals/Subclavius

The real problem here could be too many chest days and not enough leg days!

Poor resting posture during the day and poor technique with exercise are often the true culprits. Falling into a slumped position on a regular basis can put the pectorals in a shortened position.

This faulty posture can lead to excessive impingement, as well as increased tone and trigger points in the pectoral muscles.

The subclavius runs deep to the pecs. It attaches between the clavicle and the first rib, often referring pain to the front of the shoulder. You can usually address this spot while working on the upper fibers of the pecs.

Scalenes

These muscles run on the front, side and back portion of your neck.

The scalenes are one of the many muscles responsible for moving your neck. If you tend to adopt a forward head posture or a slight tilt of the head to the left or right these muscles may be engaged more often than necessary.

Having a forward head posture means that you are passively hanging on these muscles for support during the day. This can lead to increased tone and trigger points. We also tend to see issues in the scalenes show up following a whiplash injury.

The scalenes are also involved in breathing. If you tend to be an upper chest breather these muscles may be taking a beating. Keep in mind, adopting this breathing style can lead to increased tension in the neck and thorax, as well as feelings of anxiety. After you do some soft tissue work, be sure to be more aware of posture and work on accessing your diaphragm.

Infraspinatus

The infraspinatus in one of the four infamous rotator cuff muscles.

It runs right on top of your shoulder blade.

Dysfunction in this muscle tends to show up regularly with shoulder pain. Trigger points in the infraspinatus are a problem because they alter timing and strength of this muscle (or any muscle). This alters normal mechanics at the shoulder with overhead activities. Often leading to an unstable shoulder with excessive impingement taking place.

We wrote another article in the past that discussed how referred infraspinatus pain also resembles carpal tunnel syndrome. This is not the easiest muscle to treat on your own, but don’t skim over it.

Final Consideration:

In some instances, performing soft tissue work around the shoulder will do the job just fine. This does not mean we can overlook the pieces that may have contributed to this injury in the first place. Your goal is to control what you have the ability to control.

What can you control?

1. You can normalize the tissues surrounding the shoulder.

Treat local trigger points, normalize muscle flexibility and reduce stiffness. The goal is to restore normal shoulder mechanics to the best of your ability. Treating muscle stiffness and trigger points helps optimize the timing and strength of the muscles around the shoulder to enhance stability.

2. You can also modify your activity for the time being.

If a certain activity worsens your pain, back off. It is possible that your shoulder is inflamed and needs some time to recover. This is not a fast pass to weeks off from the gym with your best friend Netflix. This means more attention on soft tissue work and flexibility. You also want to gradually return to exercise. Experiencing some discomfort during exercise is ok.

“Poke the bear, but don’t take it to dinner.”(in reference to pain)

– Adriaan Louw

 Interested in a FREE Mobility Program to treat pain at the front of the shoulder? Click here

About the Author

Dr. Michael Infantino is a physical therapist. He works with active military members in the DMV region. You can find more articles by Michael at RehabRenegade.com.

 

 

 

 

References

Gill HS, El Rassi G, Bahk MS, et al. Physical examination for partial tears of the biceps tendon. Am J Sports Med 2007; 35:1334.

Skendzel JG, Jacobson JA, Carpenter JE, Miller BS. Long head of biceps brachii tendon evaluation: accuracy of preoperative ultrasound. AJR Am J Roentgenol 2011; 197:942.

Stephen M Simons, MD, FACSM, J Bryan Dixon, MD Section, Biceps tendinopathy and tendon rupture
Uptodate.com

Taylor SA, O’Brien SJ. Clinically Relevant Anatomy and Biomechanics of the Proximal Biceps. Clin Sports Med 2016; 35:1.