I’m a doctor of physical therapy that works with many people who have biceps tendonitis, tendinopathy, and various other types of shoulder pain.
Surgery can be an option for severe biceps tendinopathy but is rarely the first option. Physical therapy, NSAIDs, heat, ice, massage, and other options should be exhausted (in most cases), prior to going down the surgical path.
Here’s what we will cover in this article:
- When surgery might be necessary for bicep tendinopathy
- What’s the difference of tendinitis, tendinosis, and tendinopathy
- Whether ice or heat is better for biceps tendinitis
- What is a SLAP tear
- The attachment points of the bicep tendon
What Is The Difference Between Biceps Tendonitis, Tendinosis, and Tendinopathy?
Tendonitis
Tendonitis is an acute, short-term, inflammatory process usually due to overstretching or overexerting a tendon. It lasts up to 7 days from the initial onset of pain.
Tendinosis
Tendinosis is not an acute inflammatory reaction but is classified as a chronic thickening of the collagen fibers of the tendon. Tendinosis is not always associated with pain and in many cases, people have tendinosis and don’t even know it.
Tendinosis does not put you at a higher risk of developing pain.
Tendinopathy
Tendinopathy is an umbrella term that defines any sort of pain, or differing structural integrity of the tendons. Essentially, tendinopathy is the broad term (parent term) of tendonitis and tendinosis.
This includes tendinosis, which oftentimes is asymptomatic.
When is Surgery The Right Option?
When you might need to get surgery sooner rather than later:
- You experienced a severe trauma that severed the bicep tendon at the proximal or distant attachment
- You’ve lost most function in your arm due to severe pain that hasn’t gotten better over several weeks and months, despite medication, physical therapy, ice/heat, etc.
If you’re wondering why your bicep is taking forever to heal, you’ll want to read this article linked in this sentence.
What you should usually try before considering surgery
If the pain onset is due to overexertion, overstretching, or something related to that, it’s recommended to try the following before consulting a surgeon:
- Physical Therapy. A physical therapist will be able to evaluate and range of motion loss, strength loss, pain levels, and help you come up a rehab plan that will help you get your full function back without surgery. I would recommend going through a rehab plan for at least 2-3 months before considering alternatives.
- Sometimes it’s also reasonable to continue with rehab for 6+ months if symptoms are steady and not increasing, and are tolerable during your daily life.
- NSAIDs, Ice, and Heat. You should try different medications (as appropriate for any health conditions you might have), and also use heat and/or ice to help calm symptoms.
- Massage. This can also help to calm symptoms to make your daily life more tolerable as you give your body time to heal.
Read this article if you want to know if lifting weights with biceps tendinitis is ok.
What Are The Attachment Points of The Bicep Tendon?
The bicep muscle has two sections; the long head of the bicep tendon, and the short head of the bicep tendon.
The long head of the bicep tendon runs through what’s called the intertubercular groove and then attaches to the supraglenoid fossa with a portion of it also attaching the superior labrum. This is all happening at the front and top of the shoulder.
You’ve likely heard of a SLAP tear before. This is why it’s called that. I’ll discuss it below in a bit more detail.
The short head of the bicep tendon attaches at the coracoid process. This is in the front of the shoulder, but lower and sits under the pectoralis major (large chest muscle). This portion of the tendon is less frequently irritated.
Distally (towards the elbow), the bicep tendon attaches, together, at the radial tuberosity on the radius bone. This is an inch or two past the elbow and down onto the forearm.
This is why as your bicep contracts, it pulls on your forearm, pulling it towards your body/shoulder.
Is Ice or Heat Better?
Use whichever one feels best. There is no significant advantage to using ice or heat with any sort of tendon issue.
In other articles, I’ve written about whether ice or heat is better for injuries and the takeaway is that each person needs to choose what feels best for them.
Neither ice nor heat, significantly change the cellular mechanisms behind inflammation. They are symptom modifiers (i.e. they make it feel better in the short term).
What is a SLAP Tear?
A SLAP tear stands for, Superior Labrum Anterior Posterior Tear. In layman’s terms, this means you have a tear on the top of the labrum in your shoulder and the long head of your bicep tendon from front to back.
A SLAP tear, in athletes often does require surgical intervention, but, the first line of defense is usually physical therapy as some will benefit from this.
Key Takeaways
- Surgery can be an option if you have a SLAP tear, or if you have a bicep tear that is completely detached and creating a severe loss of function.
- Tendinitis and tendinosis are different. If you’ve had this issue for a while it’s likely not tendinitis anymore.
- Try rehabbing with physical therapy first before surgery (in most cases)
