Sports Medicine – Upper Arm

The biceps muscle is found in the front of the upper arm and is attached to the shoulder and lower arm bone by tendons. It helps control lower arm movement and is particularly instrumental in the follow through of forceful throwing movements such as those in football or baseball. When the tendons are overused or overstressed, they become irritated and inflamed. This condition is called Biceps Tendonitis. It is often secondary to rotator cuff instability.

Biceps tendonitis may cause pain along the front of the shoulder during arm and shoulder movement – particularly forward and upward movements. Pain may intensify at night and become increasingly prevalent during daily activity such as lifting or carrying groceries or garbage bags.

Those at Risk
While athletes in throwing sports are often diagnosed with this condition, it can affect any active male or female who repetitively overuses the biceps muscle. A direct trauma or calcification in the tendon may also prompt the condition.

Diagnosis
Following patient history, physical examination and pain analysis, radiographic testing will confirm diagnosis.

Treatment
Biceps tendonitis is generally treated with a conservative nonsurgical program involving anti-inflammatory medication and cold compression. A rehabilitative exercise program designed to strengthen and promote flexibility of the shoulder stabilizers is developed. Depending on the severity of the pain, corticosteroid injections may be indicated in order to reduce the inflammation and pain. And an ongoing rehabilitation program is developed specifically to the patient in order to ensure a safe return to sport with no recurrence.

The biceps muscle bends the arm at the elbow and rotates the forearm in order to allow the palm of the hand to face upward. It is located at the front of the arm and is attached by the biceps tendon to the shoulder blade (scapula) and the radius bone.

The biceps muscle separates near the shoulder into a long head and a short head – both of which attach to the shoulder in different places. The long head of the biceps tendon is subject to injury because it travels through the shoulder joint to its area of attachment.

A biceps tendon rupture may occur as a result of chronic tendonitis – and a long history of shoulder impingement and stability problems. While ruptures of the distal tendon near the elbow are less reported than those of the proximal tendon, they can occur with unexpected force on a bent arm in breaking a fall or shielding from a collision.

Most frequently diagnosed are ruptures of the proximal biceps tendons near the shoulder. Because of the broad range of motion the shoulder joint can attain and to which it is subjected, the proximal biceps tendon is more vulnerable to injury than the distal biceps tendon.

Proximal biceps tendons tears can be either partial or complete and are often times already a bit worn – particularly in the patient over 40 years of age.

Pain is usually sharp and sudden, often times preceded by a loud “snap.” There may be a bulge in the upper arm above the elbow and an indention nearer the shoulder – possibly accompanied by bruising, pain or tenderness.

Those at Risk
Athletes subjecting their shoulder to extreme throwing force are vulnerable and likely to experience this condition during their career. Active adults who over exert in an activity, or who have a history of shoulder instability problems and degenerative tendon conditions are also at risk. In the elderly, proximal biceps tendon ruptures (in the shoulder area) are generally seen in conjunction with rotator cuff tears.

Diagnosis
Along with patient history, a physical examination involving arm movement and tightening of the biceps muscle will help determine diagnosis. For patients with a history of shoulder pain and instability, magnetic resonance imaging (MRI) or arthrogram (enhanced X-ray) may be indicated, in order to assess the condition of the rotator cuff muscles.

Treatment
Conservative nonsurgical treatment is usually successful in treating biceps tendon ruptures. This may entail cold compression in order to reduce swelling, nonsteroidal anti-inflammatory drugs (NSAIDs), and a period of rest followed by a rehabilitative strengthening and flexibility program that is specific to the patient.

When the condition is nonresponsive to conservative treatment, surgery to repair the tendon tear may be performed. This depends on the patient’s history, age and work requirements.

The triceps tendon is likely to become inflamed and rupture when overstressed while lifting weights or pushing something that is too heavy. It can also rupture when outstretched arms are used to break a fall.

The triceps tendon is located at the back of the upper arm and inserts into the back of the elbow. The symptoms of inflammation or a rupture may include elbow pain at rest or during activity, painful swelling at the back of the elbow, and reduction in elbow function.

Those at Risk
Those frequently lifting large amounts of weight at the gym without properly strengthening opposing muscle groups are at risk of triceps tendon inflammation or rupture. Also vulnerable are skateboarders or roller bladders, who rely on outstretched arms to break a fall.

Diagnosis
Along with patient history, a physical examination involving arm movement and tightening of the triceps muscle will help determine diagnosis. For patients with a history of elbow pain, magnetic resonance imaging (MRI) or arthrogram (enhanced X-ray) may be indicated in order to assess the condition of the elbow joint and associated tendons.

Treatment
Conservative nonsurgical treatment is usually successful in treating triceps tendon inflammation or ruptures. This may entail cold compression in order to reduce swelling, nonsteroidal anti-inflammatory drugs (NSAIDs), and a period of rest followed by a rehabilitative strengthening and flexibility program that is specific to the patient.

When the condition is nonresponsive to conservative treatment, surgery to repair a tendon tear may be performed. This depends on the patient’s history, age and level of activity.