ARM & SHOULDER TENOSYNOVITIS, BICEPS-TENDON SHEATH
DEFINITION--Inflammation of the lining of the biceps-tendon sheath in the upper arm and shoulder. This lining secretes a fluid that lubricates the tendon. When the lining becomes inflamed, the tendon cannot glide smoothly in its covering.
BODY PARTS INVOLVED
Biceps tendon, which attaches the biceps muscle to the shoulder.
Lining and covering of the biceps tendon.
Soft tissue in the surrounding area, including blood vessels, nerves, ligaments, periosteum (covering to bone) and connective tissue.
SIGNS & SYMPTOMS
Constant pain or pain with motion.
Limited motion of the shoulder and elbow.
Crepitation (a "crackling" sound when the tendon moves or is touched).
Heat and redness over the inflamed tendon.
Restriction of movement followed by a sudden painful snap, if the tendon breaks away from its attachment to bone.
Strain from unusual use or overuse of the biceps muscle.
Direct blow or injury to the shoulder. Tenosynovitis becomes more likely with repeated injury to the biceps muscle-tendon unit.
Infection introduced through broken skin at the time of injury or through a surgical incision after injury.
RISK INCREASES WITH
If surgery is needed, surgical risk increases with smoking, poor nutrition, alcoholism or drug abuse, and recent or chronic illness.
HOW TO PREVENT
Engage in a vigorous program of physical conditioning before beginning regular sports participation.
Warm up adequately before practice or competition.
Wear protective gear appropriate for your sport.
Learn proper moves and techniques for your sport.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's examination and diagnosis.
Surgery (sometimes) to enlarge the tunnel of the tendon covering and restore a smooth gliding motion. The surgical procedure under general anesthesia is performed in an outpatient surgical facility or hospital operating room.
Your own observation of symptoms and signs.
Medical history and physical examination by your doctor.
X-rays of the area to rule out other abnormalities.
Blood and urine studies before surgery.
Tissue examination after surgery.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury of the biceps tendon.
Adhesive tenosynovitis: The tendon and its covering become bound together. Loss of motion may be complete or partial. Surgery is necessary to remove the covering or transfer the tendon to a new area.
Constrictive tenosynovitis: The walls of the covering thicken and narrow the opening, preventing the tendon from sliding through. Surgery is necessary to cut away part of the covering.
Rupture of the tendon, if motion is forced when the tendon and its covering are bound together.
PROBABLE OUTCOMETenosynovitis is usually curable in about 6 weeks with heat treatments, corticosteroid injections and rest of the inflamed area. Recovery is usually quicker if the inflammation is caused by a direct blow rather than by a strain or sprain.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDNone. This problem develops slowly.
Wrap the shoulder with an elasticized bandage or use a sling until healing is complete.
Apply heat frequently. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
MEDICATIONYou may use non-prescription drugs, such as acetaminophen, for minor pain. Your doctor may prescribe:
Stronger pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need.
Injection of the unruptured tendon covering with a combination of a long-acting local anesthetic and a non-absorbable corticosteroid such as triamcinolone.
ACTIVITYResume normal activities slowly.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
Begin daily rehabilitation exercises when supportive wrapping is no longer needed.
Use ice massage for 10 minutes before and after exercise. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of biceps tenosynovitis.
Any of the following occur after surgery:
Increased pain, swelling, redness, drainage or bleeding in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
New, unexplained symptoms. Drugs used in treatment may produce side effects.