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BICEPS TENDINOPATHY

Biceps Tendinopathy is described as pain and tenderness in the bicep tendon. It can sometimes be inflamed due to overuse activities which can cause painful movements. It can also occasionally result from direct injury. Biceps Tendinopathy is usually associated with other shoulder pathology like impingement syndrome, rotator cuff tears or instability.

SYMPTOMS

Pain is more of a dull ache on the top of the shoulder. It usually worsens on overhead activities and on twisting movements of the forearm. This pain can also make the arm feel weak.

INVESTIGATION

A thorough clinical exam is extremely important in diagnosis. X-rays are can sometimes show bony spurs or small bony outgrowths that form along the edge of a bone, in the region of the biceps tendon, however, they also help rule out other pathology which can cause similar symptoms. MRI scan is useful to help diagnose this condition.

TREATMENT PROCEDURES

Non-Surgical

Treatment is usually conservative with pain killers and physical therapy. This treatment can be quite prolonged and may cause the patient to get frustrated. The pain may come and go depending on the patient's activities. Avoiding those activities which causes pain and resting the shoulder can help control the pain. Concomitant pathology like impingement syndrome can also be treated at the same time with physiotherapy. In certain cases, your doctor may advise a pain-killer injection into the tendon sheath to help control the inflammation and pain.

Surgical

Surgical treatment is usually in the form of biceps tenotomy or tenodesis. In biceps tenotomy, the tendon is detached from its attachment on the superior labrum and released. This is usually reserved for elderly individuals. This treatment can cause slight weakness of outward twisting of the forearm. It can also cause a lot of cramping and bunching up of the biceps tendon distally towards the elbow causing a 'popeye' appearance.

Younger patients are usually advised a biceps tenodesis where the tendon is detached from its attachment on the superior labrum and reattached to the proximal humerus. This can be performed either by an arthroscopic technique or open technique as is usually called since it involves a small incision. Usually the tendon can be attached to the soft tissue in the proximal humerus (the upper part of the arm bone that joins to the shoulder socket) directly to the bone by drilling a socket and attaching it with a bioabsorbable screw. This procedure avoids the 'popeye' appearance and cramping is less. There is only about 10-15% loss of straight movement compared to the opposite shoulder.

Physical therapy in case of a tenotomy can be started immediately to help regain movements in the shoulder. To stabilize the joint by anchoring the tendons, light physical therapy is started after a short period of rest in a sling. Active movements are started after about 3 weeks.

Shoulder Pain

The most complex yet largest joint of the human body comprises the humerus that is fitted into the scapula as a ball fits in a socket joint. Although shoulders are subjected to a lot of movement, the majority of injuries that occur in a shoulder may be treated without performing any surgeries.

 

Why Do I Get?

A shoulder pain could be due to an injury in the ligaments or tendons. Some common reasons which cause shoulder pain include:


•    Breakdown of soft tissues As one gets older, doing strenuous shoulder activities can lead to a faster breakdown of the soft tissues.
•    Strain Overexertion can affect your shoulder andlead to shoulder pain.
•    Tendonitis The soft tissues around the muscles become inflamed with overuse. This inflamed condition is known as tendonitis.
•    Dislocation An unnerving pain could be experienced with a dislocated shoulder.
•    Arm Bone Fracture Cancer or meningitis, fibromyalgia are some other reasons for neck pain.A fractured upper or collar arm bone can give one an upsetting shoulder pain.

Other factors include, frozen shoulder and pinched nerves.

Shoulder Fracture(s)

Pain can also occur in the shoulder from diseases or conditions that involve the shoulder joint, the soft tissues and bones surrounding the shoulder, or the nerves that supply sensation to the shoulder area. The clavicle and shoulder joint are the two common forms of shoulder fractures. to completely diagnose the precise cause of the shoulder pain. These include: A physical exam followed by appropriate tests recommended by the doctor will be required


X-Ray of the neck
•    MRI of the neck
•    CT Scan of the head or neck
•    Blood tests
•    EMG or NCV

Diagnosis

A physical exam followed by appropriate tests recommended by the doctor will be required to completely diagnose the precise cause of the neck pain. These include:


•    X-Ray of the neck
•    MRI of the neck
•    CT Scan of the head or neck
•    Blood tests

Treatment

Location of the fracture actually impacts the treatment that is provided to the patient with a fractured shoulder. Generally shoulder pains can be treated with RICE!


•    (R) Rest Give your shoulder rest for about a day.
•    (I) Ice Pamper your shoulder with an ice-pack. Place it on your shoulder for about 20 minutes for about 4-8 times a day.
•    (C) Compression Bandage your shoulder tightly or compress the area where there is a swelling.
•    (E) Elevation Keep the injured shoulder elevated above the heart's level; using a pillow could be helpful.

After a thorough diagnosis of the source of pain, generally, anti-inflammatory medication, antidepressants, pain relievers, pain relieving injections and so on may be provided to relieve shoulder pain.

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