yogabook / pathologie / biceps tendinitis
Contents
biceps tendinitis
Definition of
Usually inflammatory irritation of the long biceps(origin) tendon in the area of the intertubercular sulcus between the two tubercles of the humeral head
Cause
- Usually the result of chronic overuse (lifting or carrying too much weight, inadequate training), or sudden overload
- Wear and tear (degeneration due to incorrect loading or overloading, usually from the age of 50) Misalignment of the shoulder joint
- tendon-damaging medication (e.g. gyrase inhibitors) and diseases
Predisposing
- subacromial impingement syndrome
- Frozen shoulder (acute phase)
- RA
- Cortisone therapy
- Frequent overhead work
- Sports that put strain on the shoulder joint such as javelin throwing
- (similar factors to SLAP lesion)
- Damage to the pully complex, the soft tissue guide loop (tendons of the supraspinatus and subscapularis and coracohumeral ligament)
Diagnosis
- Sonography shows thickening and fluid accumulation (edema) around the distended biceps tendon , caput longum,
- X-rays may show calcification of the tendon, an interruption of the calcification pathway indicates a tendon rupture
- MRI
- Palpatory tenderness and possibly swelling over the intertubercular sulcus
- Tests and signs: Speed test, Palm up test
Symptoms
- Dull to sometimes stabbing pain in the ventral humerus, more deeply localized during frontal abduction, lateral abduction, retroversion, as well as subordinately during flexion of the elbow joint, which runs along the course of the tendon of origin of the long head of the biceps. Brenen’s is also described.
- Pain may radiate in the direction of the forearm
- Pain-related restriction of strength Tension pain, pressure pain in or over the affected tendon
- Rarer: jumping, snapping, cracking
Therapy
- Treatment is usually conservative; in mild cases, healing can take place in 5 – 14 days with consistent rest, but can also take weeks to months.
- Anti-inflammatory drugs, iontophoresis
- Infiltrations (Traumeel/Zeel)
- Autologous conditioned plasma
- Physical therapy: ultrasound, cryotherapy, shock wave therapy
- Osteopathy
- Stretching training
- PT: transverse friction, longitudinal friction, taping
- If the cause is overuse: load reduction
- Tenotomy with fixation in the sulcus or suture anchor (tenodesis) for structurally severely damaged tendons
- Sports that strain the arm only after healing
DD
- Impingement syndrome of the shoulder (subacromial impingement)
Complications
- Tendency to chronification
- Over time, the structure of the biceps tendon can be weakened to such an extent that the tendon ruptures. The tendon r upture can become noticeable primarily through a reduction in pain, rather than a loss of strength, as the long tendon only bears approx. 10-15% of the load compared to the short tendon. Then the Popeye sign appears, a proximally displaced long head. A distal tendon rupture would show the reverse Popeye sign (both heads displaced distally )
- A torn long biceps(origin) tendon is considered not to be sutured or refixed
Asana practice and movement therapy
The first important measure is to reduce strain. Heavy carrying and lifting as well as heavy frontal abductions are contraindicated in the acute inflammatory phase, as is immobilization of the shoulder joint. Movements may not be pain-free, but – especially in the case of the shoulder joint – flexibility must be maintained and cartilage lubrication ensured. In principle, the level of tension and flexibility of the biceps should be checked. Stretching the biceps can also make a significant contribution to relieving the tendon. Muscular imbalances in the shoulder area must be addressed. It is not uncommon for the dorsal muscles of the shoulder joint to lack strength. The improved straightening of the rib cage should also have a positive influence, i.e. a reduced tendency to hyperkyphosis of the thoracic spine as well as a reduced tendency to protraction of the shoulder blades.
Asanas
- Asanas in 602: Strengthening the autochthonous back muscles
- Asanas in 311: Stretching the biceps
- Asanas in 272: Strengthening the exorotators of the shoulder joint
- Asanas in 671: Stretching the rectus abdominis
- Asanas in 676: Stretching the oblique abdominal muscles
- Asanas in 307: Strengthening the biarticular triceps
- Asanas in 227: Strengthening the retractors of the shoulder blade