Bicep Tendon Injury - Proximal?

[buckley187]

Hi guys,

I am not sure if any of you can assist me or offer me some advice? But I have a pain in the front of my shoulder. If I am resting its fine, there is no swelling and it's painless. If however I place my arm out in front of me and turn my palm upwards (supination) then I get a nasty pain right in the front of my shoulder. If my palm is facing down then I can lift my hand over my head without pain.
However, if I touch my shoulder with the same hand and tense my bicep I get a nasty pain. This pain is at the very top of my bicep into my shoulder and not in the bulk of the bicep itself. Even putting my shorts on and the pulling up motion causes me pain. My bicep doesn't look disfigured at all and I feel like I've got the same power but I just cannot use or have the mobility due to the pain. Can you tell me what it is? Any advice and help would be much appreciated! Is it Bicep Tendonitis or something else? I'm really confused????

Just for your info as well:

This injury happened while in the gym I think??? I was using a bench and pressing some weights. I felt a pull at the very front of my shoulder and like a fool continued my workout, despite it being a bit uncomfortable. I am also a keen rock climber so this sport is heavily focused on bicep, lat and forearm work.

Anyway 7 weeks later after not doing anything, taking anti-inflammatory and performing hot and cold bathing on the injury it's no nearer to going away or the pain easing off and I don't know why? Is this normal? I have been ice packing my bicep and shoulder every night as well.

I have been seeing a physio who is not 100% sure themselves it seems. They don’t seem to offer a clear explanation and help me understand my problem. I have asked to see a consultant. I will but that's a couple of weeks off yet...

I just need some help and wondered if anyone who knows much about this sort of injury can help me or if anyone that has experienced this can offer some words of advice?

I can't play sports and it's getting to me!

Sorry it's long winded but I wanted to explain everything as best as I could.

Many Thanks

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[Orihc]

Buckley,
orthopedic testing is probably required in this case to determine if the long head of the bicep or subscap tendons have been torn.
My suggestion is MRI it will tell you exactly what is going on, and there is no guess work involved.
If i had to hazard a guess i would say you have torn one if not both of the tendons mentioned above.
C

[buckley187]

Ok, thanks for your advice.

If that is the case then what would be the next step? Let the Tendon heal itself? Or would you normally have an op for something like this?

As I say there is no pain in the actual shoulder itself nor from the tendon that goes over the top of my shoulder (fom the bicep). The pain is right at the very front where the tendon inserts from the bicep. No pain when my palm is facing downwards.

[Orihc]

Buckley,
Wait for your appt with the orthopod, he will send you for an MRI with a gandolium injection, this will determine exactly what is wrong!
what country are you in? as Physio/GP'sand other allied health practitioners have access to MRI in certain country's.( saves waiting for orthopod )
If the tendon is partially torn then soft tissue therapy from any allied health prac along with exercises will help. If completely torn then you will need a minor op. hard to give advice on this until MRI reveals all.
Good Luck
C

[charlize29]

Hi Buckley,

You being a rock climber and your activity at the gym has probably contributed to the repetitive microtrauma of the biceps in the bicipital groove. In fact you have provided key points such as: not being able to mobilize your arm due to pain(intiatiating activites), a negative bunching up of the biceps in the distal arm which is evident in proximal biceps tendon rupture is a good sign. ( you may rule out rupture of the proximal part which is one of the clinical findings),activites that involve repetitive flexion of the shoulder and elbow,( rock climbing) and overloading of the biceps (bench presses eccentric contraction of your biceps)

This attachment best describes biceps tendinopathy and its treatment.


Hope this one helps!!

regards,
Charlize29

[buckley187]

Hi Buckley,

You being a rock climber and your activity at the gym has probably contributed to the repetitive microtrauma of the biceps in the bicipital groove. In fact you have provided key points such as: not being able to mobilize your arm due to pain(intiatiating activites), a negative bunching up of the biceps in the distal arm which is evident in proximal biceps tendon rupture is a good sign. ( you may rule out rupture of the proximal part which is one of the clinical findings),activites that involve repetitive flexion of the shoulder and elbow,( rock climbing) and overloading of the biceps (bench presses eccentric contraction of your biceps)

This attachment best describes biceps tendinopathy and its treatment.


Hope this one helps!!

regards,
Charlize29

HI Charlize29,

Thank you very much for the info and word doc. I had a good read of it last night and it helped me understand my injury a bit more. I've done so much research on this injury on the net but there doesn't seem to be anything on how long an injury like this takes to recover? I understand that I have to be patient but it's hard for someone very active like me.

Anyway I'll keep going with the hot and cold treatment and I'm having physio twice a week now so I'm hoping within a few weeks I'll be sorted, considering it's been 7 weeks since the injury happened!

Like I say thanks for the doc and also for taking the time to write back and offer some advice and info.

I'll keep you guys posted and we'll see how it all goes.

One last thing I thought i'd mention; I'm only getting pain against resistance with my palm up? If I support my arm with my palm up and lift there is virtually no pain there... it's very odd and VERY annoying.

[charlize29]

Hi Buckely,

A positive Speed's test is when you move your arm ( shoulder ) in front of you or flex it with the elbow extended while the forearm is in a supinated position with resistance. That definitely puts a strain on your biceps tendon in the bicipital groove..yes it can be very annoying . Try not to do activites that aggravate the condition. Your patience will pay off soon so do not worry too much

Thanks also for presenting your case and goodluck to you. Get well soon!!
Please keep us posted ok....

Regards,
charlize29

[buckley187]

Morning guys,

See the physio again last night and he has advised that I need to just keep going with my stretching exercises and said that my shoulder capsule was very tight to start with. This is getting better. Last night my shoulder and bicep where sore after physio but this morning it's settled down a bit.

So he's said NO scan (MRI) for now just keep going with this treatment and ultrasound? He said it's pointless having an MRI when he already knows what the problem is!

Do you think he's right???

Another thing I haven't mention is that my left shoulder has never had the ROM my right shoulder has. In terms of flexibility. This is imrpoving but my tendon feels very similar to what it was say 2-3 weeks ago.. Is this normal?

I'm so impatient eh!

Please let me know your thoughts.

Many Thanks

[Orihc]

Buckley,
You have had this problem now for nearly 9 weeks, you have been having physio twice a week for the past 4 weeks, if this was a simple bicep problem it would have been resolved by now. Obviously this is more complex, the physio should get the MRI just to cover his own backside. GO GET AN MRI. I send for MRI all the time, even if the scan comes back with diagnosis that the physio original said, it will do 2 things. 1) puts your mind at rest and 2) gives the physio a clear cut picture of what is going on and a time frame to work with, i still don't understand why practitioners don't use scans as often as they should.
C

[buckley187]

Buckley,
You have had this problem now for nearly 9 weeks, you have been having physio twice a week for the past 4 weeks, if this was a simple bicep problem it would have been resolved by now. Obviously this is more complex, the physio should get the MRI just to cover his own backside. GO GET AN MRI. I send for MRI all the time, even if the scan comes back with diagnosis that the physio original said, it will do 2 things. 1) puts your mind at rest and 2) gives the physio a clear cut picture of what is going on and a time frame to work with, i still don't understand why practitioners don't use scans as often as they should.
C

Hi Orihc,

I have physio again tonight so I'll insist on an MRI and see what they say and follow your advice. I will keep you informed and let you know the outcome!

I thought I should have had a scan a long time ago...

They did say I can see a consultant if this problem continues, either way I need to do something.

Thanks very much for your advice and comments.

[buckley187]

Ok well see a physio last night and after me having a bit of a moan he has agreed that I need to see a consultant. He said that I may just have a steroid injection (something I'm not keen on). I specifically asked for an MRI as I want to know what is exactly wrong with my shoulder/bicep tendon before they stick a needle into me.

I'm still in pain, although not as much but it's a very long winded process!

So that's me at the moment! Thanks for all your responses and for taking the time to look through my posts.

[Konradslavinskis]

Buckley,

While you are waiting for your MRI and also appointment, are you doing any strengthening work for your rotator cuff muscles? Has the physio checked for posterior capsule tightness and also scapulohumeral rhythm? Please remember that regardless of the MRI or appointment you will need to fixed the stuctures that have been effected by the actual injury. So make sure that you get as strong as you can (safely and non aggravating). The MRI will give you a strcture but you may need help eg. CSInjection to help settle the pain to allow you to strengthen.

Enjoy

Konrad

[jwilso]

Hi Buckley,
there is still time for improvement and so my advice is to be patient. a steroid injection may help but there are risks involved. if you have a partial tear of your biceps tendon the steroid could weaken the tissue further and then you could end up with a complete rupture. Your consultant may refer you for an MRI but if this is on the NHS you will have a several month wait for this and so dont expect things to happen quickly. my advice to you is to keep going with the physio and see how things go. it is possible that you have impingement of either the biceps or the rotator cuff and this may be why you arent getting better. it may be a postural problem or like the others have pointed out tight pectorals or tgiht posterior capsule might be the problem. the aggravating factor needs to be established. good luck

john

[buckley187]

Konrad,
Yes I've been using a stability ball and also performing exercises that target my rotator cuff. I have also been stretching every night as I was told by my physio that I have a tight shoulder capsule (AC joint??).

It was considerably tighter than my other shoulder as well. If you can imagine laying down and putting your arm behind your head my arm only had something like 70% of the ROM that my right arm has. I could not get my hand to the floor and to be honest it's always been a lot less flexible than my other shoulder? But I've been stretching for the past month and it has improved a great deal. It's still not as flexible as the other arm but I'm getting there. It doesn't seem to cure the pain though?

Could this non-ROM have been the cause of it? I'm not sure?

Finally in response to John:

I have private medical insurance so I can have an MRI a couple of days after seeing a consultant so I've been advised. I'll keep going with the physio then John and take your advice on board.

How would you know if you have impingement or a tear? Do they feel different? Is the pain different that I feel as well. As to me it's very specific on certain movements, mainly supination or weight bearing.

How do you treat impingement and get rid of the pain?

Thanks again.

[Orihc]

hey buckley,
Forget the physio for the time being, get the film, get the results then post them on here for opinions to be expressed. my advice stop wasting your money at physio. ( 10 weeks of physio is alot of physio at twice a week )
C