Shoulder pain is caused by many conditions, including arthritis and tendinitis. Daily activities may be difficult with these disorders, particularly ones that require overhead reaching. Biceps tendinitis and arthritis typically develop over time with repetitive overuse of the arm. Although shoulder arthritis does not directly cause biceps tendinitis, these conditions frequently occur together.
Anatomy
The shoulder joint is a ball-and-socket, remarkably capable of moving in any direction. Because it is so mobile, the shoulder is also prone to injury. The joint is formed by the upper arm bone and part of the shoulder blade. A separate bony projection of the shoulder blade forms a roof over the shoulder joint. Tendons attached to muscles that move the shoulder travel between the ball of the joint and this roof, including the biceps tendon.
Overview
Two types of arthritis commonly affect the shoulder joint. Osteoarthritis causes breakdown of the cartilage between the ball and socket of the shoulder joint. Cartilage breakdown may progress to the point that the bones of the shoulder joint grind against each other, causing pain and limiting movement. Rheumatoid arthritis is an autoimmune disorder that causes the body to mistakenly attack healthy joint tissue, causing damage and loss of joint function. Both conditions can affect the position of the ball in the socket of he shoulder joint.
The biceps tendon is located at the front of the shoulder. It moves the arm straight out in front of the body. Biceps tendinitis is typically caused by repetitive use of the arm, particularly reaching overhead. Although arthritis is not a proven cause of biceps tendinitis, it may be a risk factor. The position of the ball in the shoulder socket can be altered by arthritis, causing the tendons to be pinched between the ball and bony joint roof. This condition, called subacromial impingement, may be associated with biceps tendinitis because the tendon passes through this space.
Conservative Treatment
Shoulder arthritis with biceps tendinitis is commonly treated with physical therapy. Heat, ultrasound, electrical stimulation and massage are used to decrease pain and muscle tightness around the shoulder. Range of motion exercises are performed to increase movement of the shoulder joint. These exercises should be performed in a pain-free range to prevent symptoms from getting worse.
Manual stretching is performed by the therapist to improve flexibility of the shoulder joint to prevent it from freezing – getting stuck in a tight position. Strengthening exercises target the muscles that stabilize the shoulder, keeping it in proper position as the arm moves. This reduces the likelihood of the biceps tendon being pinched in the subacromial space. Antiinflammatory medications, such as aspirin and ibuprofen (Motrin, Advil), and cortisone shots are frequently used by doctors to treat these conditions.
Surgery
Surgery is sometimes required to treat severe pain and limited movement from shoulder arthritis and biceps tendinitis. Arthroscopy is often performed first. Three small incisions are made in the shoulder for insertion of a tiny camera, bone shaver and miniature scalpel. Frayed tissue and irregular bone are shaved away and scar tissue around the biceps tendon is removed. If the tendon is damaged, part of it may need to be removed. The remaining part of the tendon is reattached to bone in the shoulder.
Severe shoulder arthritis may require joint replacement. The ball of the upper arm bone and the socket of the shoulder blade are removed. An artificial ball and socket are then placed by the surgeon. Physical therapy is required after surgery to restore shoulder function.