Monday, November 13, 2017

PT Pathologoies: Bicipital Tendonitis

          Bicipital tendonitis, also known as biceps tendonitis, is a common cause of shoulder pain among individuals.  It is an "inflammatory process of the tendon of the long head of the biceps,"  This condition is often caused by repetitive activities or motions that occur overhead, but can also be caused secondary to other pathologies involving the shoulder.  Certain athletes are at high risk of developing biceps tendonitis, such as baseball pitchers, tennis players, gymnasts, rowers, and swimmers.  Individuals with this condition normally complain of "a deep ache directly in the front and on top of the shoulder".  The ache also tends to spread into the biceps muscle.  Certain activities, such as lifting overhead, tend to make the ache worse, while rest tends to ease the pain.  There are several indicators that can confirm bicipital tendonitis.  These positive indicators include painful palpation in the area of the bicipital groove, pain with the biceps resistance test, and a positive Speed's Test. (Bicipital Tendonitis p. 246).
          There are a number of effective ways to manage bicipital tendonitis.  "The primary goal of medical management is to relieve pain, reduce inflammation,  and regain full available range of motion."  Rest, immobilization, and splinting or bracing can be used initially, as well as the use of pharmacological interventions.  This includes the use of NSAIDs, which reduce pain and inflammation.  It is also recommended to apply hot and cold to the affected area.  This can aid in relieving pain.  These are all effective ways to manage bicipital tendonitis.
           Although active physical therapy is not initiated immediately after bicipital tendonitis is diagnosed, it is initiated once the individual has progressed out of the acute phase.  In the acute phase, individuals may be recommended to participate in certain pendulum exercises, the use of TENS, and be given certain restrictions.  After progressing out of the acute phase, the goal of physical therapy is to stretch and strength the muscle group is affected.  This can, in turn, restore the functional ability of the tendon  It can also improve healing and prevent future injury.  If the individual does not progress with physical therapy intervention, surgical intervention may be recommended, however the last resort.
          As previously mentioned,  physical therapy is initiated once individuals with bicipital tendonitis have progressed out of the acute phase.  The anticipated goals/expected outcomes that are relevant to bicipital tendonitis include a reduction in pain, swelling, inflammation, restriction, and soft tissue swelling, improved joint integrity, mobility, functional limitations, and range of motion and to help enable the individual to participate in physical activities, work leisure activities etc (Morphopedics 7).  Manual therapy interventions may be used, which include massage mobilization/manipulation, and passive range of motion, as well as physical agents, which include cryotherapy, ultrasound, taping, and continuous passive motion (CPM).

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