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Bicep pain can be caused by several factors, including injuries, muscle strain, tendonitis, or a tear in the bicep tendon. It can also be caused by everyday activities such as lifting heavy objects or overusing muscles. Bicep tendonitis, a common cause of bicep pain, occurs when the tendon in the bicep muscle swells and becomes inflamed, often due to repetitive overhead motions or overuse. Other causes of bicep pain include brachial plexus injury, fractures, and rotator cuff injuries. Treating bicep pain is crucial to prevent long-term damage and restore normal function.
| Characteristics | Values |
|---|---|
| Cause | Tendonitis, brachial plexus injury, fractures, muscle strain, tendon tear, rotator cuff injury, shoulder impingement syndrome, bicep bruise, broken humerus, bicep tendon rupture |
| Symptoms | Pain, tenderness, snapping sensation, muscle spasms, cosmetic deformity ("Popeye muscle"), dull ache, decreased arm strength, clicking or popping sound, bluish discolouration, swelling, weakness with movement |
| Treatment | Cold packs, nonsteroidal anti-inflammatory drugs, physical therapy, stretching, rest, surgery, pain relievers, medication, rehabilitation |
| Risk Factors | Age, overuse, repeated overhead motions, sports, heavy lifting, degenerative changes due to aging, rotator cuff injuries, tendon damage, fraying |
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What You'll Learn
Biceps tendonitis
The condition can also be caused by a sudden, serious load on the tendon, such as lifting heavy objects, or from micro-tears in the tendon generated by overuse or exceeding the tendon's strength. In its early stages, the tendon becomes inflamed and swollen, causing pain and tenderness in the front of the shoulder. As inflammation progresses, the tendon and its sheath can become more irritated, leading to thickening and, in some cases, fraying or a complete tear.
Common symptoms of biceps tendonitis include pain and tenderness in the area in front of the shoulder, which may worsen with physical activity or when lifting the arm overhead. There may also be upper arm muscle pain that radiates down the upper arm, and a snapping sound or sensation in the shoulder. In some cases, biceps tendonitis can cause a cosmetic deformity, often referred to as a "Popeye" bulge in the upper arm.
Treatment for biceps tendonitis typically begins with non-invasive methods such as rest, ice, pain relievers, and nonsteroidal anti-inflammatory drugs like ibuprofen or paracetamol. Physical therapy, including stretching and strengthening exercises, can also help improve symptoms and restore function. However, in severe cases or when non-invasive methods are ineffective, surgery may be required.
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Brachial plexus injury
Bicep pain can be caused by several conditions, one of which is a brachial plexus injury. The brachial plexus is a network of nerves that carries signals from the upper spinal cord to the shoulder, arm, and hand. These nerves are responsible for movement and sensation, allowing actions such as raising the arm, moving the wrists, and using the hands.
Brachial plexus injuries typically arise from trauma to the neck, but they can also be caused by pressure, stress, athletic injuries, or being stretched too far. In newborns, brachial plexus injuries can occur during birth, particularly when the baby's shoulders are impacted during delivery, causing the brachial plexus nerves to stretch or tear. This condition is known as Erb's palsy when affecting the upper brachial plexus and Dejerine-Klumpke palsy or Klumpke's palsy when impacting the lower brachial plexus.
There are several ways in which the brachial plexus nerves can be injured. Compression neuropraxia occurs when the nerve root is compressed, often by head rotation, and is the most common form, frequently affecting older individuals. Traction neuropraxia, on the other hand, happens when the nerve is pulled downward and is more common in adolescents and young adults. Brachial plexus injuries can also result in neuromas, where scar tissue forms after a nerve tear, leading to a painful knot on one of the nerves. In severe cases, a rupture or avulsion may occur, where the nerve tears or is cut/torn from the spinal cord, respectively.
The symptoms of a brachial plexus injury include pain, weakness, and numbness in the arm and hand. Depending on the severity of the injury, some individuals may recover normal function, while others may experience lifelong disabilities. Many minor brachial plexus injuries result in a 90%-100% recovery of arm function. However, in more severe cases, surgery may be necessary to restore function.
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Fractures
In addition to physical trauma, bone metastasis can also cause fractures in the bicep area. Bone metastasis is a condition where cancer cells spread to the bones, weakening them and making them more susceptible to fractures. This can be a serious complication of cancer and may require immediate medical attention.
The severity of a fracture can vary, ranging from hairline fractures to complete breaks. Hairline fractures are small cracks in the bone, while complete breaks are when the bone breaks into two or more pieces. The treatment for fractures can also vary depending on the severity and location of the fracture. It may include immobilization, where the arm is placed in a sling or cast to stabilize and protect the fracture site. In more severe cases, surgery may be required to realign the broken bones and stabilize them with metal hardware.
To diagnose a fracture, a doctor will typically order an X-ray, which can reveal any breaks or cracks in the bone. In some cases, a CT scan or MRI may be necessary to get a more detailed view of the fracture and the surrounding soft tissues. Early diagnosis and treatment of fractures are crucial to ensure proper healing and recovery of arm function.
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Tearing of the distal biceps tendon
A distal biceps tendon tear is a complete or partial tear that occurs when the tendon tears away from its insertion point on the radius bone. The tear usually occurs as a result of a forceful, eccentric contraction of the elbow—when the biceps muscle is contracting but the elbow is straightening, resulting in lengthening of the muscle-tendon unit. For example, this can happen when a person tries to lift a heavy object by bending their elbow, but the weight of the object forces the elbow to straighten instead. Tears of the distal biceps tendon are uncommon and typically occur as a result of an injury or lifting a heavy object. When this tendon tears, the tear is usually complete, and the muscle is separated from the bone and retracted toward the shoulder. This causes weakness in powerful palm-up activities like tightening a screwdriver.
The classic symptoms of a distal biceps tendon tear include feeling a “pop” or tearing sensation in the front of the elbow, along with pain, swelling, and bruising in the area. In some cases, patients may only experience a partial rupture, where the tendon is torn but not completely detached. These patients often have pain in the front of the elbow and pain with forearm twisting (supination). A complete distal biceps tendon rupture can result in the tendon and muscle retracting toward the shoulder, creating a cosmetic deformity that resembles a rounded mass in the upper arm, sometimes called a "reverse Popeye deformity".
To diagnose a distal biceps tendon tear, a physician will typically examine the patient's medical history and perform a physical examination to determine if there is a deformity, locate the site of injury, check if the tendon is still intact, and assess for pain and weakness with elbow flexion and supination. Imaging tests such as X-rays, ultrasounds, and Magnetic Resonance Imaging (MRI) scans may also be used to confirm the diagnosis and evaluate the extent of the injury.
Treatment options for a distal biceps tendon tear include both conservative (non-operative) management and surgical intervention. Partial tears are usually initially treated with conservative methods, while surgery is typically recommended for patients with full-thickness tendon ruptures, those who are very active, and those who have not responded to non-operative treatments. Surgical treatment involves reattaching the distal biceps tendon to the bone using techniques such as suture anchors, surgical buttons, bone tunnels, and/or screws. Chronic ruptures that have occurred several weeks or months prior to seeking treatment may be more challenging to treat surgically due to tendon retraction and scar tissue formation.
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Biceps bruises
The pain from a biceps bruise can be felt in the middle of the biceps and may be tender to the touch. It may also radiate from the shoulder down into the biceps area. Other symptoms include bluish discolouration, swelling, and skin bruising. The affected muscle may also feel weak or stiff, with difficulty using the joint near the injury.
Most biceps bruises heal with at-home treatment, and the pain usually subsides within a few weeks. Applying ice packs to the affected area for 20 minutes at a time, several times a day, can help reduce swelling and pain. Over-the-counter nonsteroidal anti-inflammatory drugs, such as ibuprofen or paracetamol, can also help manage the pain and swelling.
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Frequently asked questions
Bicep muscle pain can be caused by several factors, including bicep tendonitis, brachial plexus injury, and fractures.
Bicep tendonitis is an inflammation or irritation of the upper portion of the biceps tendon, which connects the biceps muscle to the shoulder or elbow. It is often caused by overuse or repetitive overhead motions.
Bicep tendonitis is usually treated with non-invasive methods such as rest, ice, pain relievers, and physical therapy. In severe cases, surgery may be required.
