Biceps Tendonitis: Say It Ain't So, Cole

Phillies ace Cole Hamels was diagnosed with bicep tendonitis and will not be available to pitch opening day.  Hearing that causes an immediate concern of rotator cuff (RTC) irritation, which could lead to another long season for the fans to watch. According to a study completed in 2008 by Friedman et al, of all patients with biceps tendinitis, 95% usually have another injury associated with the tendinitis such as a tear in the rotator cuff, or a superior labrum anterior to posterior (SLAP) lesion. AHHHHH! Hopefully this is not the case for Cole! Let’s take a quick look at why baseball players are at risk for biceps tendonitis.

Anatomy

Your biceps tendon actually has 2 parts and connects up in your shoulder as shown in the picture below. The long head of the biceps connects into the glenoid (shoulder socket) and blends in with the glenoid labrum (which provides stability to the shoulder by extending the area of the socket).  The short head connects to the coracoid process of your shoulder blade. The main function of the biceps is to bend your elbow but these 2 connections demonstrate how and why this muscle can be a burden to overhead athletes.  

How does the biceps tendon become inflamed?

The close connection to the labrum and ligaments surrounding  the shoulder cause the biceps to also play a role in stability of the joint. Therefore, if a person or pitcher has loose ligaments this causes more strain on the other stabilizers surrounding the joint including the biceps and RTC tendons.  Damage to the biceps tendon can also occur if the rotator cuff is weak and unable to fully perform its job of maintaining the head of the shoulder within the socket, which is especially important during the throwing or pitching movement. If the RTC is weak or damaged this would allow for the arm bone to slide forward and push on or impinge biceps tendon. Any continuous or repetitive shoulder actions can cause overuse of the biceps tendon and the throwing motion is one of the most stressful, repetitive activities for the shoulder.  Damaged cells within the tendon don't have time to recuperate or the cells are unable to repair themselves, leading to tendonitis.

Symptoms of biceps tendonitis

• pain in the front or side of the shoulder and the upper arm
• pain in the arm at night, especially when you sleep on that side
• pain when you move your arm, raise it above your head, or reach behind you
• shoulder weakness and stiffness
• loss of some motion in the arm

Treatment

Treatment for biceps tendonitis is typically conservative care. Seeking treatment early increases your chance of a positive outcome. The initial goals of treatment are to control inflammation and swelling and rest from the aggravating activity. Physical therapy is often utilized to restore shoulder motion and strengthen your scapular/dynamic stabilizers to reduce stress being placed on the biceps tendon during throwing. Physical therapy will also be important to strength the leg and core muscles so the entire throwing chain will be improved to further reduce overload on the biceps and RTC. Once full ROM and strength are achieved an interval throwing program is initiated to gradually return the athlete back to sport.

Are you or your children having any pain in the front of their shoulder? Schedule an appointment today to take care of the issue early before it affects them all season.

Friedman DJ, Dunn JC, Higgins LD, Warner JJ. Proximal biceps tendon: Injuries and management. Sports Med Arthrosc. 2008;16(3):162-169.

Ryan McDevitt, PT, DPT