Inflammation of the biceps tendon

definition

The biceps is a two-headed arm muscle that attaches to the socket of the shoulder joint and ends in the area of ​​the elbow on the forearm. He's for that Flexion of the arm responsible in the elbow and for the Rotation of the palm up.

The biceps is made up of two tendons, a long and a short biceps tendon. Usually is from the Inflammation of the long biceps tendon affected. The inflammation causes Deposition of calcium saltswhereby the Limited movement of the biceps tendon and the tendon becomes more and more damaged over time.

In addition to the biceps tendon, the supraspinatus muscle or other muscles of the so-called is often affected at the same time Rotator cuff the shoulder.

root cause

Certain physical activities can lead to a Inflammation of the biceps tendon to lead. Are often affected professional athletes or people who intense sport operate. Sports that are more likely to develop biceps tendonitis include, among others lift weights, swim such as ball- and Throwing Sports. Generally speaking: sports in which there is one heavy load on the shoulder comes.

In rare cases, inflammation can also be caused by a trauma arise.

Often the biceps tendonitis is one Accompanying phenomenon to another shoulder disease. For example, it often accompanies a so-called impingement syndrome or as part of a rheumatic disease.

This fact comes about because the long biceps tendon runs through large parts of the shoulder joint and is bathed in synovial fluid, so that it is usually affected by inflammation and other diseases of the shoulder.

Symptoms

The Pain the inflammation mainly occurs in the front area of ​​the shoulder. The pain has a dull, sometimes stabbing character. Sometimes they also radiate into the elbows.

Especially with Pressure on the tendon or at one Stretching the muscle the inflammation is noticeable through pain. The pain is of course also caused by Movementswhere the biceps are tensed, this is when Flexing the elbow the case, as well as the Outward rotation of the forearm. The pain also occurs often at night when lying down on the shoulder.

Often it happens to severe restrictions on movement. In rare cases, the inflammation causes one swelling in the shoulder area. Some patients also report one Snap or Crack in the shoulder area.

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diagnosis

The Diagnosis takes place by the doctor on the basis of a conversation and a physical examination. In the investigation we will Biceps tendon palpated and specific tests are carried out.

A specific test for examining the long biceps tendon is, for example, the so-called Palm-up test. That's what the Arm extended forward and deviates outwardly from the body axis by about 30 degrees, the Palm up shows. The examiner then makes a resistance exercised while the patient tries to bend the arm in the crook of the elbow. If there is irritation of the long biceps tendon, this examination causes pain. The palm-up test is however not specific to inflammation the long biceps tendon. There may also be another pathology.

In addition, an ultrasound examination will often be carried out. If there is an inflammation of the tendon, this is shown by an ultrasound thickening the tendon and possibly as effusion fluid seen that builds up with inflammation. In some cases, magnetic resonance imaging can be used as a support for imaging.

Conservative treatment

Will be a Inflammation of the biceps tendon established, should definitely first of all apart from sporting activities otherwise there is a increased risk of degeneration the tendon and Limescale deposits.

Especially in the acute to subacute phase Physiotherapeutic treatment should take place to strengthen the weakened muscle culture of the shoulder.

In addition to physiotherapy, cold therapy (Cryotherapy) has proven its worth in treatment. However, this will only in the acute phase applied to inflammation.

Furthermore, a Ultrasound therapy or electrotherapy with electrical stimulation is prescribed by the attending physician.

Kinesio taping is also widely used. The kinesio tape is elastic, self-adhesive therapeutic tape. Among other things, they are said to have tension-relieving and anti-inflammatory effects. However, the effect has not been scientifically proven. In the case of the inflamed biceps tendon, the tape is in the form of a Y-strip glued to the shoulder.

As soon as it is possible for the patient again, should certain movement exercises be carried out that often repeated must be carried out with small weights. These exercises are mostly together with the physiotherapist carried out and can then be continued alone after completion of the treatment.

Accompanying the already mentioned therapy options are often pain reliever and anti-inflammatory drugssuch as ibuprofen or diclofenac taken. In the acute stage you can also Syringescontaining, among other things, cortisone injected into the shoulder joint be which one anti-inflammatory and analgesic effect have.

Overall, if the shoulder not calcified is that the therapy options are better. If none of these therapeutic measures show any effect, the inflammation of the biceps tendon must be operated on become.

Operative treatment

Beats the no conservative therapy the inflammation is called refractory to therapy and the Biceps tendon needs surgery become. A so-called endoscopic surgery carried out.

For endoscopy only need several very small cuts be made, through which the endoscopes are pushed into the arm. Endoscopes are tools that are needed during surgery, including one camera through which the surgeon can see what he is doing. One speaks of one Lock and key principle.

Stand for biceps tendonitis two different procedures to disposal:

On the one hand the Tenodesiswhere the part of the tendon that is inside the shoulder joint partially removed and the remaining stump in a bone canal above the sliding channel by means of a Fixation screw is attached. The approx thirty minute surgery usually takes place under general anesthesia.

The other possibility is the Tenotomy The tenotomy also involves removing part of the tendon, namely the part that is at the upper edge of the socket of the shoulder joint. The remainder of the tendon can then within the channel located there slide that Bicipital sulcus. In the bicipital sulcus, the tendon can then heal and stabilize again.

With tenotomy, this is the case riskso that the tendon slides deep into the sliding channel. This then makes itself through a Bulging of the biceps abdomen noticeable. Sometimes it can also fade away on its own Muscle spasms come.

The Flexion power of the biceps by approx 15% decreased which usually does not affect the person concerned in everyday life.

Especially with young, slim men the optical change of the biceps are often bothersome during tenotomy, which is why tenodesis is carried out more often. However, the Tenotomy better overall results and leads to fewer problems.

Furthermore, especially with the Tenodesis up to about three months after the operation Sports and no vigorous activities become.

If the surgeon notices during the operation that he cannot see enough due to the endoscopic operation, this can also refer to a open surgery be expanded.

Often the long biceps tendon is not inflamed alone, but still exists Clinical picture for example in the area of ​​the rotator cuff. In these operations there is usually a Anesthesia of the nerve plexuswhich runs in the arm instead of, one speaks of one Scalenus block.

The usually takes place one to two days after the operation Discharge from the hospital. After the operation, the patient must continue to receive physical therapy. This takes place directly on the day of the operation and then extends over a period of four to six weeks. To two to three weeks you can go back to sports that do not put pressure on your shoulders, such as jogging. Sports with shoulder strain or exerting force with the shoulder should only be done after consulting the surgeon six to twelve weeks be performed.

Prognosis / course

Often there may be inflammation of the biceps tendon relatively persistent be so a Healing for weeks to months can last. As a rule, however, they are right well treatableso that they heal after a shorter time. How long the healing process takes is individually different.

Takes the Inflammation for a very long time, can cause the biceps tendon weakened and cracked become.