Bicipital Tendon Injection

Biceps (bicipital) tendinitis is an inflammation of the long head of the biceps tendon as it passes through the bicipital groove of the anterior humerus (see the image below). ^{[1, 2]}

Bicipital tendon.

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Repetitive lifting and, to a lesser extent, overhead reaching can lead to inflammation, microtearing, and, if the condition goes untreated, degenerative changes. Patients with bicipital tendinitis typically report anterior shoulder or humeral pain aggravated by lifting or overhead reaching. The patient often takes one finger and points directly to the bicipital groove when describing the pain. Patients may not be able to flex at the elbow against resistance because of the pain of active tendinitis.

Anesthetic block may be necessary to distinguish the pain from the referred pain of rotator cuff pathology. The diagnosis is mostly clinical and specialized radiographic testing is rarely necessary.

The goals of therapy for bicipital tendinitis are as follows ^[1] :

• Reduce tendon inflammation and swelling
• Strengthen the biceps muscle and tendon to prevent repeat inflammation
• Prevent  rupture

Local corticosteroid injection may be used to relieve symptoms in patients with symptoms that persist for more than 4 weeks despite conservative treatment. Long-term outcome, however, is much the same for patients who undergo joint injection to treat bicipital tendinitis as for those who do not.

Physical therapy is helpful for most of these patients.

Bicipital groove injection, the most precise anatomic injection, is recommended in patients younger than 50 years.

The risk of tendon rupture is greater in patients aged 50 years and older. A subacromial injection is preferred in this population because it avoids direct needle penetration of the tendon.

Corticosteroid joint injection can speed up recovery from bicipital tendinitis in high-performance athletes, but this is a controversial indication.

Few absolute contraindications exist for joint or soft-tissue aspirations and injections. The procedures should probably be avoided if the overlying skin or subcutaneous tissues are infected or if bacteremia is suspected. The presence of a significant bleeding disorder, diathesis, or severe thrombocytopenia may also preclude joint aspiration.

Aspiration of a joint with a prosthesis carries a particularly high risk of infection and is often best left to surgeons using full aseptic techniques. If infection is suspected as the underlying cause of the musculoskeletal problem, corticosteroids must not be injected, because they may exacerbate the infection.

Warfarin anticoagulation with international normalization ratio (INR) values in the therapeutic range is not a contraindication for joint or soft-tissue aspiration or injection.