Introduction
Especially repetitive overhead lifting in front of the body puts a special strain onto the biceps tendon where the long head tendon inserts into the rotator cuff. Certainly, this leads to biceps tendinitis (I am using “tendinitis” and “tendonitis” spelling synonymously).
Everything I mentioned above about “shoulder impingement”, “rotator cuff tendinitis” and “rotator cuff tear” applies here.
For one thing, if the biceps tendinitis is severe and chronic enough, the brittle tissue will eventually break and a rotator cuff tear at the insertion site of the biceps tendon into the rotator cuff will result. In fact, the key to the diagnosis is the observation that there is pain in the front part of the shoulder with activity and with resisted forward flexion, particularly in the overhead position. In particular, when pain from the shoulder injury persists, the physician likely orders an MRI scan.
MRI scan shows biceps tendinitis
It is important to realize that the MRI scan at this stage may show the biceps tendinitis, or the complete tear of the rotator cuff. With this in mind, in the case of a biceps tendinitis the physician likely will order modified work duties or advise the patient to take a break from the strenuous sports activity. Another key point, often with modified activities, utilization of other muscles and physiotherapy treatments it is possible to cure the tendinitis. In particular, topical non-steroidal anti-inflammatories such as Pennsaid can be applied to the skin over the location where there is tendinitis. To emphasize, this topical medication can penetrate considerably deep into the tissues, deep enough to reach the inflamed tendons.
Topical anti-inflammatory
In other words, this preparation is a mixture of the anti-inflammatory Diclofenac (1.5%) and the vehicle DMSO, which also has anti-inflammatory properties. By all means, the doctor can even order compounded medicine that a pharmacist will mix with Lecithin and 5 to 10% Diclofenac, which is used as a cream or patch using saran wrap (Ref.7). To summarize, shoulder surgery is required for more serious injuries of the shoulder, such as arthroscopy or shoulder decompression.
References
1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999.
2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999.
3. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders
4. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
5. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
6. Wheeless’ Textbook of Orthopaedics: http://www.wheelessonline.com/ Several topics can be found under this link by entering the term you search for.
7. Dr. Taunton, Professor at the University of BC, Vancouver, and Sportsmedicine Director of the Allan McGavin Sports Medicine Centre in Vancouver at the 50th Annual St. Paul’s Hospital Continuing Medical Education Conference for Primary Physicians, Nov. 16 – 19, 2004
8. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008
