Brief Outline of Bicipital Tendinitis

Bicipital tendinitis results from irritation and inflammation to the biceps brachii tendon, which has lies on the front of the shoulder and allows bending of the elbow and supination of the forearm. Overuse can lead to inflammation and is a common affliction in golfers, weight lifters, rowers, and those engaged in throwing sports.

Anatomy and physiology

Tendons are tough, resilient bands of fibrous tissue, connecting muscle to the bone. Irritation of the tendon due to overuse occurs as it passes back and forth in the intertubercular (bicipital) groove of the humerus, and can cause inflammation of the tendons (known as tendinitis) as well as the tendon sheaths or paratenons. The musculo-tendinous junction of the biceps brachii is highly susceptible to injuries brought on by overuse, particularly following repetitive lifting activities.

Cause of Bicipital Tendinitis

Poor technique, particularly in weight lifting. Sudden increase in duration or intensify of training. Impingement syndrome.

Signs and symptoms of Bicipital Tendinitis

Pain over the bicipital groove where the tendon is passively stretched, and during resisted supination and elbow flexion. Pain and tenderness along the tendon length. Stiffness following exercise.

Complications if left Bicipital Tendinitis unattended

Bicipital tendinitis, left without care and treatment, generally worsens as the biceps brachii tendon becomes increasingly irritated and inflamed. Movement and the ability to perform athletically without pain will be furthered hampered. Exercising without adequate healing rehabilitation can lead to tearing of the tendon and tendon degeneration over time.


Rehabilitation and prevention for Bicipital Tendinitis

The condition is self-limiting given rest and minimal medical attention. Following full recovery, exercises directed at improving flexibility, propioception, and strength may be undertaken. Thorough warming-up and stretching exercises and a steady athletic regimen that avoids sudden, unprepared increases in activity can help avoid this injury, as can attention to proper sports technique.

Long-term prognosis for Bicipital Tendinitis

A full return to athletic activity may generally be expected,  given adequate time for tendon recovery and reduction of inflammation. However, the injury is frequently recurrent. Surgery is generally not required. Injections of anti-inflammatories are sometimes used to reduce pain and inflammation.

Shoulder Specialist Treating Bicipital Tendinitis

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore

Brief Outline of Shoulder Bursitis

Shoulder bursitis is not generally an isolated condition, but is usually associated with a rotator cuff tear, or impingement syndrome, and occurs when the region between the upper arm bone (humerus) and tip of the shoulder (acromionI) becomes inflamed. Tennis, baseball, and weight training are all prone to this injury.

Anatomy and physiology

Tendons of the rotator cuff act to rotate the upper humerus, raising the arm by pulling the humeral head down. At the same time, the deltoid muscle pulls the arm up. This process can lead to irritation due to pressure from the acromion process of the scapula and the coraco-acromial ligament. Such irritation can affect the bursae – fluid-filled sacs providing a cushion between the bones and the tendons – leading to inflammation and accumulation of excess fluid, further limiting the space available for tendon movement. The subacromial bursa is the largest and most commonly injured bursa in the shoulder region.

Shoulder Bursitis

Cause of Shoulder Bursitis

Overuse of the shoulder from throwing activites, tennis, swimming or baseball. Falling onto an outstretched arm. Infection of the bursa in the shoulder.

Signs and symptoms for Shoulder Bursitis

Pain in the shoulder, particularly when raising the arm. Pain when turning over in bed on injured shoulder. Loss of strength and limited motion of the shoulder.

Treatment for Shoulder Bursitis

Rehabilitation and prevention for Shoulder Bursitis

The athlete should avoid pressure to the injured shoulder and inflamed bursa(e) during recovery as well as any activities likely to irritate the condition. Begin exercising the shoulder when instructed  by a medical professional in order to restore strength and shoulder mobility. Warming-up and cooling-down exercises, with an emphasis on stretching, strength training and maintaining looseness in the shoulder can help prevent bursitis from developing.

Long-term prognosis for Shoulder Bursitis

Shoulder bursitis tends to ease with proper healing and minor rehabilitation, and a full recovery to athletic activity can usually be expected, particularly if no infection of the bursa is detected. In some cases, aspiration of bursa fluid by needle is recommended to reduce inflammation and ensure no infection is present.

Shoulder Specialist Treating Shoulder Bursitis

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore

Brief Outline of Rotator Cuff Tendinitis

Rotator cuff tendinitis results from the irritation and inflammation of the tendons of the shoulder in the area underlying the acromion. The condition is sometimes known as pitcher’s shoulder though it is a common injury in all sports requiring overhead arm movements, including tennis, volleyball, swimming and weight lifting, in addition to baseball.

Anatomy and physiology

The shoulder (or glenohumeral) joint is a ball-and-socket structure formed by the top portion of the arm bone (humerus) associated with the scapula or shoulder-blade. The rotator cuff aligns the head of the humerus into the scapula. Occasionally, following repetitive use of the rotator cuff, the humerus can ride up to pinch the cuff and irritate the fluid-filled subacromial bursa that acts to cushion the rotator cuff and acromion/humerus.

Cause of Rotator Cuff Tendinitis

Inflammation of the tendons of the shoulder from tennis, baseball, swimming, etc. Irritation of the bursa of the rotator cuff from repetitive overhead arm motion. Pre-existing disposition including anatomical irregularity.

Signs and symptoms of Rotator Cuff Tendinitis

Weakness or pain with overhead activities, brushing hair, reaching, etc. Popping or cracking sensation in the shoulder. Pain in the injured shoulder, particularly when lying on it.

Complications if left Rotator Cuff Tendinitis unattended

Rotator cuff tendinitis can worsen without attention as the tendons and bursa become increasingly inflamed. Motion becomes more limited and tendon tears can cause further, in some cases, chronic pain. Further, the acromion may react to prolonged irritation with the production of bone spurs, which contribute to further irritation.

Treatment for Rotator Cuff Tendinitis

Rehabilitation and prevention for Rotator Cuff Tendinitis

Following the rest and healing of the injured shoulder, physical therapy should be undertaken to strengthen the muscles of the rotator cuff. Occasionally, injections are required to reduce pain and inflammation. Moderation of rotator cuff use, adequate recovery time between athletic activities, and strength training can all help avoid the injury.

Long-term prognosis for Rotator Cuff Tendinitis

Given proper rest as well as physical therapy and (where needed) injections, most athletes enjoy a full recovery from this injury. Should a serious tear of the rotator cuff tissue occur, surgery may be required, although a recovery to pre-injury levels of activity is usually expected.

Rotator Cuff Tear
Rotator Cuff Tear

Shoulder Specialist Treating Rotator Cuff Tedinitis

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore

Brief Outline of Shoulder Impingement Syndrome

Shoulder impingement syndrome is a chronic condition caused by repetitive overhead activity or throwing events that damage the glenoid labrum, long head of the biceps brachii, and the subacromial bursa. A narrowing of the space between the rotator cuff and the acromion results in shoulder pain and loss of movement, due to deficit in the affected rotator cuff, a group of muscles and tendons necessary to secure the arm to the shoulder joint. The rotator cuff permits free rotation of the arm.

Shoulder Impingement

Anatomy and physiology

The rotator cuff is composed of four muscles: subscapularis, supraspinatus, infraspinatus and teres minor, as well as their musculo-tendinous attachments. The subacromial bursa (a fluid-filled sac), is the largest and most commonly injured bursa in the shoulder region, and provides the rotator cuff with lubrication to assist movement. The rotator cuff acts to stabilise the glenohumeral joint. Damage, including tears to the rotator cuff, can cause the humeral head to migrate during elevation of the arm, leading to impingement.

Cause of Shoulder Impingement Syndrome

Repeated overhead movements as in tennis, swimming, golf, and weight lifting. Irritation of the rotator cuff due to throwing sports including baseball. Underlying predisposition, including rheumatoid arthritis.

Signs and symptoms of Shoulder Impingement Syndrome

Shoulder pain and difficulty raising the arm in the air. Pain during sleep when the injured arm is rolled on. Pain during rotational movements such as reaching into a back pocket.

Complications if left Shoulder Impingement Syndrome unattended

Increasing stiffness of the joint and further loss of motion may result should impingement be ignored. Rotator tendons may be torn, should athletic activity be undertaken prior to full recovery. Tendinitis and bursitis frequent develop with impingement as a pre-condition.

Treatment for Shoulder Impingement Syndrome

Rehabilitation and prevention for Shoulder Impingement Syndrome

Following a period of healing, physical therapy will often be used to restore strength and range of motion in the affected rotator cuff. Avoiding or limiting repetitive motions that cause rotator cuff irritation may help prevent the injury. Strengthening exercises and lightweight training to strengthen the muscles of the rotator cuff are also useful preventive measures.

Long-term prognosis for Shoulder Impingement Syndrome

Typically, the condition shows marked improvement within 6-12 weeks. In cases where recovery has not been achieved in 6-12 months, surgery may be recommended to release the ligaments. Surgery is usually followed by physical therapy, and some modification of athletic activity may be necessary to reduce the chances of relapse.

Shoulder Specialist Treating Shoulder Impingement Syndrome

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore

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Brief Outline of Biceps Brachii Bruise

Bruising to the biceps brachii can occur following tearing and/or rupture of the biceps brachii tendon, or trauma to the muscle. The biceps brachii tendon attaches the biceps brachii muscle to bone in the shoulder region. Overstrain from weight training can cause tears and bruising, which may also result from throwing sports or following direct trauma to the shoulder during a fall or collision with another athlete.

Anatomy and physiology

The biceps brachii muscle is located on the front of the upper arm, and operates over three joints. Its function is to allow bending of the arm and to support loads places on the arm. This muscle has two parts, known as the long head and short head, both connected to bone via the biceps brachii tendon. This muscle runs down the anterior or front side of the upper arm and allows motion of the forearm towards the shoulder (elbow flexion). The biceps brachii muscle also allows turning the hand face down or face up. This is known as pronation or supination of the forearm.

Cause of Biceps Brachii Bruise

Direct blow to the biceps brachii region of the upper arm. Biceps brachii rupture. Repetitive tearing of the biceps brachii muscle or tendon.

Signs and symptoms of Biceps Brachii

Discolouration of the biceps brachii area. Aches or pain in the biceps brachii. Stiffness and limitations of movement in the affected arm and shoulder.

Complications if left Biceps Brachii unattended

Bruising of the biceps brachii generally resolves itself without treatment. Sports involving heavy use of the biceps brachii muscle including weight training and throwing sports, and contact activities with high risk to the biceps should be avoided pending adequate time for healing.

Treatment for Biceps Brachii

  • Immobilisation with a sling to prevent excess movement
  • Physiotherapy

Rehabilitation and prevention

Rest and avoidance of activities involving stress to the biceps brachii muscle and tendons during the healing phase are generally sufficient. Range of motion exercises and graded strength training should be undertaken to restore full power and resilience to the muscle. Stretching exercises performed before athletic activity may help prevent injury and associated bruising to the biceps brachii.

Long-term prognosis for Biceps Brachii

Bruising to the biceps brachii is generally a minor condition that is self-correcting without resort to surgery, given adequate time for healing. No long-term deficit in strength or mobility is expected.

Biceps Brachii Specialist, Orthopaedic Specialist, Dr Kevin Yip

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore

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