According to the textbook "Sports Medicine A Comprehensive Approach," the shoulder is now recognized as a primary source of functional disability in a large variety of sports, particularly those with repetitive overhead motions. The textbook also states that most athletes will experience shoulder pain during their lives and will require at minimum a period of inactivity to help resolve the issue.
Bicipital tendonitis is a condition that tends to affect older patients with a mean diagnosis age of 55 years. Risk factors include overhead activities, sports, and recurrent subluxation--excessive movement and misalignment--of the bicipital tendon in its groove on the humerus.
Anatomy of Shoulder and Bicep Tendon
The shoulder consists of three bones--the clavicle, scapula, and humerus--cartilage, ligaments, and surrounding muscles. The anatomy is very complex and allows a large degree of motion.
The humerus is the largest of the bones in the upper extremity. It has attachments for muscles and ligaments. The proximal, or closest to the head, portion of the humerus is where the arm attaches to the shoulder, or scapula. On the front of the humerus, or its anterior, is a small groove. This groove is the bicipital groove and inside the groove is the bicipital tendon. This tendon attaches the biceps muscle to the shoulder. The biceps tendon is kept inside the groove by the transverse humeral ligament.
Pathology of Biceps Tendonitis
According to the text "Examination of Orthopedic and Athletic Injuries" the biceps tendon provides very little force in moving the shoulder joint but can affect range of motion, strength, and stability in the shoulder joint if injured.
Injury occurs during repetitive overhead movements of the arm. This movement causes the tendon to slide in the groove. If this is repeated the tendon can inflame and cause pain. This is called bicipital tendonitis.
Transverse Humeral Ligament
The transverse humeral ligament is designed to keep the tendon in the groove. This tendon can be torn and damaged and will therefore allow excessive movement in the groove leading to inflammation and potential tearing of the tendon.
Treatment of Biceps Tendonitis
According to "Sports Medicine A Comprehensive Approach," shoulder treatments in older adults should remain nonoperative. Rest is the number one recommendation given to older patients. Rest should be in the form of refraining from overhead activities and those that aggravate the area or cause pain. Range of motion exercise is necessary to keep the joint mobile. Other forms of treatment include physical therapy, chiropractic, ice and medications.
When to Seek a Professional
If shoulder pain does not improve or there is a substantial loss of function it is advised to see a professional.
References
- "Examination of Orthopedic and Athletic Injuries Edition 3"; C. Starkey, S.D. Brown, J. Ryan; 2010.
- "Sports Medicine A Comprehensive Approach 2nd Edition"; G. R. Scuderi, P.D. McCann; 2005.
