Bicipital Tendonitis


Bicipital tendonitis is a very common condition affecting the front of the shoulder or elbow.  The biceps muscle flexes our elbow and aids in flexing of the shoulder.  The bicep muscle is made of 2 seperate muscle that share a common attachment. The muscle attaches to forearm bone called the ulna at a common site.  The origination of the muscle is in 2 separate location on the shoulder blade.  The first attachment is in the front of the shoulder just under the collar bone to a protrusion off the scapula called the coracoid process. The second attachment is just above the cup on the scapula where the arm bone ball articulates to make the shoulder joint.   The most common site of  tendonitis called proximal bicipital tendonitis occurs at the location where the bicipital tendon takes a 90 degree turn after passing through the bicipital grove before attaching above the shoulder cup.  The second site site of  tendonitis called distal bicipital tendonitis occurs at the attachment of the biceps muscle at the elbow.

Symptoms of Proximal Tendonitis

  • Pain in the front of the shoulder during hand elevation overhead.
  • Pain in front of shoulder while reaching backward.
  • Pain in the front of the shoulder flexing the elbow

Symptoms if Distal Tendonitis

  • Pain in the front of the elbow when flexing the arm.
  • Pain in the front of the elbow when carrying heavy items.
  • Pain in the front of the elbow when straightening the arm.

Treatment of Bicipital Tendonitis

First we need to rest the arm.  Usually this condition occurs due to overworking the muscle.  We then use Chiropractic Care and Massage Therapy to correct muscle imbalances around the scapula leading to poor mechanics within the shoulder joint.  We also instruct patients on stretching muscles to aid in making postural corrections of the shoulder and neck.  At home we also recommend Contrast Therapy to decrease inflammation and speed healing.

Tennis Elbow

What is Tennis Elbow?

Tennis elbow is a tendonitis of the finger/wrist extensor tendons at attachment of the elbow.  The finger and wrist extensor muscles originate from the same location at the elbow just above the elbow joint.  These muscles extend the fingers and the wrist.  The tendonitis can develop from repetitive use of the extensor muscles or from overly forceful activities on the extensor muscles.  A good example of an overly forceful use would be a backhand in tennis which gives this condition its name.  Respective use is seen inpatients with desk jobs with prolonged computer work or jobs using tools such a hammer.  Tennis elbow can lead to pain in most activities once it has developed but initially it is only felt during or after the activity which caused the problem.  I have patients that get so bad they have trouble lifting a cup of coffee.  Diagnosis of tennis elbow is very easy, an experienced doctor just needs to palpate the insertion point of the tendons which will elicit the pain when touched.  The location of the pain is just above the elbow on the outside of the elbow running into the back of the forearm to the wrist.  Pain can also be reproduced by muscle testing the extensor muscles which will also cause pain in the elbow.

How is Tennis Elbow Treated?

In our office we use Chiropractic Care and Massage Therapy in conjunction with homecare.  Chiropractic Care will correct muscle imbalances in the forearm which is a major factor in the development of this condition.  It is very common to have an imbalance of strength between the finger/wrist flexors and the finger/wrist extensors.  Finger flexors are usually overly strong and become tight making the extensor muscle work harder.  Massage therapy is used to work out trigger points within the extensor muscles and relax the flexor muscles.  Massage will also be used at the insertion point to break up adhesions within the tendon and stimulate blood flow.  For complete resolution of the condition we either have patients refrain from the activity causing the problem for a short period of time or we make work/lifestyle modifications to decrease strain on the tendon. We prescribe homecare stretches for the flexor tendons and alternating ice and heat therapy to the site of tendonitis. It is also recommended to purchase a brace to help reduce strain on the tendon during activity.

5 Homecare Ideas for Tennis Elbow

  1. Stretch Wrist Flexors.  Extend the elbow straight then pull fingers back.  Hold for 10 seconds repeat 5 times.
  2. Alternate ice and heat. Using Contrast Therapy Protocol is highly effecting at reducing inflammation and promoting healing.
  3. Massage the forearm by hand or purchase a hand held massaging tool.
  4. Purchase a compression brace for tennis elbow.
  5. Rest the arm refrain from working out with arms, carrying heavy objects, and using impact tools.