Dealing With Bicep Tendon Pain

It is only normal to experience a sore bicep after an intense workout. However, when the pain becomes recurring or chronic, begins to interfere with your daily life, or compromises your athletic performance, it is crucial to seek adequate treatment and diagnosis. In some cases, the pain you experience indicates nothing more than an overworked muscle. However, sometimes it can be the telltale sign of a more severe underlying condition, such as tendonitis, a frozen shoulder, or rotator cuff problems. 

Neuragenex Neurofunctional Pain Management can help you restore the health of your bicep tendons without medications or surgery. This innovative whole-person approach will work to tackle the systemic inflammation at the root of your pain and help you re-establish optimal musculoskeletal health. Let’s see how below. 

What Pain In The Bicep Tendons Feels Like

Tendons are strong bands of connective tissue that link the bones of a joint to a muscle. They play a vital role in enabling movement and preventing abnormal or excessive motions that may lead to injury.

The upper end of the bicep muscle has two tendons that attach it to the shoulder joint:

• The tendon of the long head attaches to the glenoid (the shoulder socket)
• The tendon of the short head attaches to the coracoid process, which is a bump on the shoulder blade.

The lower end of the bicep muscle has one tendon – the distal biceps tendon – that attaches it to the radius (the bone in your forearm) at the elbow. 

These tendons are incredibly resilient and provide the arm with an extraordinary range of motion. However, certain lifestyle factors, activities, and health conditions can cause tears and inflammation, thus leading to chronic pain. 

Bicep tendon pain can feel different, depending on what’s causing it. However, if it derives from tears, inflammation, or shoulder problems, you are likely to experience these symptoms:

• Chronic pain that radiates from the top of your upper arm or shoulder
• Sudden pain at the time of injury, or dull, aching pain
• An audible “popping” sound at the time of injury
• Tenderness and weakness at the shoulder (especially around the anterior aspect of the joint) or elbow
• Stiffness in the shoulder and reduced range of motion
• Weakness when lifting objects over your head or during motions like throwing
• Trouble turning the palm or arm up or down
• Bruising 
• A visible bulge above the elbow (known as Popeye’s sign)

Factors Leading To Pain In The Bicep Tendons

While bicep tendon pain can affect anyone at any stage of life, some demographics are at higher risk. For example, athletes who regularly perform overhead and throwing motions may place undue stress and biomechanical demands on the shoulder and bicep, thus increasing their risk of injuries. 

Other risk factors include:

• Injury or trauma. Contact and non-contact trauma, such as collisions or falling on an outstretched arm, can cause the tendon to stretch beyond capacity or in an abnormal direction. Injuries such as fractures or dislocations of the shoulder may also pull on connected tendons, thus leading to tears. 
• Normal aging. The aging process causes the tendons to become stiffer and less capable of withstanding forces, which makes injuries more likely. 
• Overuse or repetitive movements. When the bicep tendons regularly sustain excessive forces, micro-tears can occur. Damage can progress over time, eventually leading to serious tears, inflammation, and irritation. Repetitive movements that affect the bicep tendons include overhead motions and lifting. 
• Poor posture. Poor posture can affect the mechanics of the shoulder and prevent loads from being distributed evenly. As the body tries to compensate, areas of the tendons may be placed under undue stress, which can increase the risk of injury. 

Health Conditions Linked To Tendon Bicep Pain

Although inflammation is the most likely culprit of pain in the bicep, there are several conditions that may cause this symptom. Below, we’ll look at the most common ones. 

Tendonitis

Tendonitis refers to inflammation or irritation of a tendon, and it is a form of tendinopathy (a condition of the tendon). This condition can be triggered by a sudden injury or emerge as a result of repetitive movements and overuse, which apply forces that exceed the strength of the tendon. These forces can lead to irritation and micro-tears, which can fuel further inflammation and lead to long-lasting pain. Common causes of tendonitis include excessive workouts, heavy lifting, and activities that involve frequent and forceful arm movements.

Although tendonitis can affect any tendon of the bicep, it is more common in the long head. In this case, the inflammation can extend to or from the rotator cuff complex, thus leading to rotator cuff tendonitis.

Bicep tendonitis can affect the shoulder or the elbow, but it is unusual to have tendonitis in both places at the same time. In the shoulder, bicep tendonitis can occur at the same time as rotator cuff tendonitis, as it is part of the rotator cuff complex. Tendonitis remains a major problem for athletes, as it accounts for 30% of all overuse injuries. In the upper body, the bicep tendons are the most frequently affected. 

Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint, which usually develops gradually over time. The causes of frozen shoulder aren’t fully understood, but it’s thought that hormones, immune system response, or lack of joint use (e.g. during periods of immobilization after injuries and surgeries) might play a role.

A frozen shoulder severely inhibits the shoulder’s range of motion, making movements stiff and painful. In turn, when you attempt to move the shoulder beyond its restricted range, the bicep tendon, which is attached to the shoulder joint, is placed under unusual stress. This can lead to further inflammation of the tendon, tears, and pain. Studies have shown that tests for bicep tendinopathy are often positive in those with frozen shoulders.

Rotator Cuff Injuries

Rotator cuff injuries are a common issue among both athletes and non-athletes. They occur when the tendons or muscles around the shoulder joint are damaged, torn, or irritated, often due to repetitive overhead motions or sudden forceful trauma (e.g. a motor vehicle collision). 

If you’re experiencing bicep tendon pain, a rotator cuff injury might be the root of the problem. This is because the bicep tendon runs through the rotator cuff, and any discomfort or inflammation in the cuff can cause pain and inflammation to radiate down into the bicep.

Studies have shown that tears in the long head of the bicep tendon are often associated with rotator cuff tears. Vice-versa, in people with rotator cuff tears, the long head tendon can be a significant source of pain. 

Tendon Tears

Although tears in the bicep tendon are not extremely common, they are often the second most likely cause of bicep tendon pain after tendonitis. Tears occur when the tendon experiences sudden trauma or is strained due to overexertion, repetitive heavy lifting, or a sudden, unexpected movement. 

A torn bicep tendon is often accompanied by a sharp pain in your upper arm and a distinct popping sound or sensation at the time of injury. After the initial pain, the tear, alongside the consequential inflammatory process, can lead to swelling, weakness, difficulty in moving the arm in certain directions, and a feeling of instability in the shoulder or elbow. The intensity of these symptoms largely depends on the severity of the tear. While mild tears can be treated through self-care strategies and activity modifications, a severely torn tendon can prevent you from moving your arm and may require medical care.

Ulnar Neuropathy

Ulnar neuropathy, also known as cubital tunnel syndrome, occurs when the ulnar nerve becomes compressed or irritated, often at the elbow. This condition can be caused by repetitive elbow movements, prolonged pressure on the elbow, or an injury. Symptoms include pain, numbness, and tingling along the inner side of the forearm and hand, as well as weakness in the hand and fingers.

When the ulnar nerve is affected, it can lead to pain that radiates up into the bicep tendon. This pain can be exacerbated by activities that involve bending the elbow or putting pressure on the ulnar nerve. Managing ulnar neuropathy often involves avoiding activities that aggravate the condition, using protective padding, and in some cases, surgical intervention.

Cervical Radiculopathy

Cervical radiculopathy is a condition that occurs when the nerves around the neck are damaged, irritated, or entrapped. It can occur due to aging joints around the neck area or bulging intervertebral discs. These conditions narrow the space in the cervical spine that houses the nerves, preventing the nerves from working properly. This can lead to disruptions in the transmission of pain, sensation, and movement signals to and from the brain. 

Some of the nerves in the cervical spine branch off to innervate the shoulder, bicep, and forearm. When these nerves are damaged or entrapped, you may experience sharp pain in your bicep tendon, as well as numbness, tingling sensations, and weakness.

Biceps Tendon Rupture

A rupture is a form of tendon tear that occurs when the tendon becomes completely detached from the nearby bone or muscle. It can occur due to a traumatic event or non-contact injury and is often a consequence of excessive force being placed on the bicep tendon when the elbow is bent. A ruptured tendon typically causes severe pain, bruising, weakness, instability, and reduced range of motion.

Ruptures can affect the bicep tendons that attach to the shoulder joint, but they may also occur in the distal attachment at the elbow. Ruptures of the distal bicep tendon are often characterized by Popeye’s sign, a visible and pronounced bulging in the bicep, and they usually require surgery. 

Diagnosing Tendon Pain

Diagnosing the root cause of tendon pain can be challenging. This is because it is a non-specific symptom common to many musculoskeletal conditions, and there is no single diagnostic test that can be used for bicep tendon pain. 

Nonetheless, your doctor may use several diagnostic tools to identify what’s causing the pain and choose an adequate treatment plan. Some of these tests include:

• A review of your symptoms and medical history 
• A physical examination, during which your doctor may palpate the painful area and assess the range of motion of the shoulder and elbow, the strength of your muscle, signs of inflammation, and tell-tale symptoms of specific conditions like Popeye’s sign
• A review of your daily activities, especially if you are an athlete involved in contact sports or regularly practice overhead throwing motions
• If necessary, imaging tests like an X-ray or MRI might be used to provide a clearer picture of the inner aspect of the bicep area

When To Seek Medical Attention

In most cases, bicep tendon pain stems from a mild strain or tear, which can be addressed with at-home care. However, sometimes, this symptom can indicate a more severe underlying condition. You should seek medical attention if:

• The pain is not going away 
• The pain worsens over time
• The reduced range of motion and discomfort are interfering with your daily life
• You experience sudden trauma, intense pain, or inability to move your arm
• You have other symptoms, such as shortness of breath and chest pain. Pain in your arm can also indicate an ongoing heart attack. 
• The pain is accompanied by severe numbness, tingling sensations, or severe weakness

Conventional Methods For Relieving Tendon Discomfort

Bicep tendon pain is typically treated using conservative methods, such as NSAIDs and steroid injections. These treatment options do very little to address the root cause of your symptoms but may be efficient in relieving pain in the short term. In severe cases – such as if your tendon is completely torn or ruptured – your doctor may also recommend surgery. Below, we’ll look at the most commonly used treatment plans for bicep tendon pain. 

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs, or non-steroidal anti-inflammatory drugs, are a class of medication used to help reduce inflammation and pain. These drugs work by blocking the COX enzyme, thus limiting the production of chemicals in your body called prostaglandins. These chemicals are responsible for triggering inflammation, pain, and fever symptoms. In turn, NSAIDs can effectively alleviate the inflammation associated with bicep tendon pain. 

However, it’s crucial to keep in mind that NSAIDs should usually only be taken for short periods, or to ease your symptoms during flare-ups. Long-term use of these medications could lead to risky side effects like stomach ulcers and even an increased risk of heart attack.

Steroid Injections

Steroid injections, also known as corticosteroid injections, are another treatment option for managing inflammation linked with bicep tendon pain. These injections work by mimicking the effects of the cortisol hormone, which the body produces naturally in response to stress. These hormones suppress the immune response and reduce inflammation, thus providing relief from bicep tendon pain discomfort. 

Nonetheless, it’s crucial to understand that steroid injections should not be a long-term solution, due to potential side effects. These include cartilage degeneration and an insufficiency of cortisol, due to a reduction in adrenal gland effectiveness.

Surgical Treatment

If you have suffered a severe tendon injury – such as a complete tear or rupture – you may need to undergo surgery to restore your arm and shoulder function. The most common surgical procedures used in these cases include:

• Biceps tenodesis. During this surgery, the inflamed or damaged part of the bicep tendon is removed and the remaining healthy portion is reattached to the humerus bone, thereby reducing pain and restoring function.
• Biceps tenotomy. During this procedure, the surgeon will cut the tendon that attaches the bicep muscle to the shoulder. This reduces the tension and, in turn, tendon irritation, which provides relief from pain. 
• Rotator cuff repair. This surgical procedure is conducted to fix tears in the shoulder’s rotator cuff and alleviate any related discomfort, including bicep tendon pain. Depending on what components of the rotator cuff are affected, the surgeon may reattach parts of the torn tendon to the bone.

All types of surgical interventions come with risks such as infections, blood clots, and allergic reactions to anesthetics. Furthermore, after a surgical intervention, you are likely to need a lengthy and painful rehabilitation period.