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Biceps Tendonitis
biceps tendonitis is common in athletes who use an overhead action (as in serving) because of excessive abduction and external rotation of the arm. It causes pain at the front of the shoulder which is aggravated by overhead activity or lifting heavy objects. The cause is inflammation of the long head tendon of the biceps muscle, as a result of direct injury to the tendon or its impingement on other structures, and treatment is similar to that for tennis elbow.
The shoulder muscles which move the arm are known as the rotator cuff muscles, and their tendons, having a poor blood supply, are particularly vulnerable to degeneration with age. Rotator cuff injuries may arise as a consequence of this or of the application of excessive force. Victims experience a vague pain that can be difficult to pinpoint and concomitant weakness, even an inability to raise the arm.
There are three (3) types of shoulder tendinitis
- rotator cuff tendinitis,
- calcific tendinitis and
- biceps tendinitis.
rotator cuff tendinitis
The rotator cuff consists of four muscles around the shoulder joint that help control the shoulder's position and keep it stable. With rotator cuff tendinitis the pain is located about three inches below the top of the shoulder and is felt when reaching overhead or behind the back. Rotator cuff tendinitis will usually resolve with rest, anti-inflammatory medications or an injection of cortisone and a local anesthetic into the area surrounding the tendon, as well as exercising using light weights. If pain is not relieved with exercise and medication alone, an x-ray of the shoulder may reveal bony anatomy that pinches the rotator cuff tendons. This occurs between a bone at the top of the shoulder (acromion) and the ball at the top of the arm bone (head of the humerus). A procedure called an acromioplasty is performed to make more room for the rotator cuff tendons. Using an arthroscope (a steel tube containing optical fibers, a lens and a light source) it is inserted into the shoulder and the surgeon is able to remove some of the bone from the acromion through two or three small 1/4" incisions.
Calcific tendinitis
Calcific tendinitis is caused by calcium deposits in the rotator cuff region. Symptoms include excruciating pain and severe restriction of shoulder motion. X-rays reveal calcium deposits within the rotator cuff or overlying the head of the humerus. Treatment includes injection of cortisone and a local anesthetic into the area surrounding the tendon. Multiple needle punctures into the calcium deposit may break up the deposit. If conservative treatment is ineffective, arthroscopic calcium removal and subacromial bursectomy are an alternative form of treatment. Subacromial bursectomy is removal of subacromial bursa sac (a small, fluid-filled sac that acts as a cushion at a pressure point in the body - often near joints where tendons or muscles cross either bone or other muscles).
Biceps tendinitis
Biceps tendinitis is inflammation of the biceps tendons that attach to the shoulder. Biceps tendinitis usually affects individuals whose occupation involves repetitive biceps flexion against resistance or whose activities include forceful throwing of a ball. Biceps tendinitis will resolve with rest, anti-inflammatory medications or an injection of cortisone and a local anesthetic into the area surrounding the tendon, as well as a sling to immobilize the shoulder. Surgery is occasionally required to stabilize a displaced tendon.
Causes
The most common causes of tendinitis are injury, overuse, infection of the tendon sheath or disease (tendinitis is evident in rheumatoid arthritis, gout and psoriatic arthritis). More often than not, the cause of tendinitis is unknown.
Diagnosis
The diagnosis of tendinitis requires a careful medical history and physical examination. To eliminate other possible reasons for the inflammation, additional tests are sometimes ordered. X-rays are usually taken to rule out abnormalities of the bones and arthritis, blood tests are used to rule out rheumatoid arthritis or diabetes, and aspiration (removal of fluid) of a swollen tendon is used to diagnose an infection or gout.
Prevention
- Proper conditioning
- Gradual introduction of activity
- Warm-up and stretching prior to exercise
- Wearing appropriate shoes for the activity
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