What is biceps or triceps tendinopathy?
The biceps is a muscle that originates from two places in the shoulder, one of which is above the shoulder socket and the other is to the coracoid. It attaches distally to the radius bone in the forearm and Its main function is in supination (rotation) of the forearm, it also assists with flexion of the elbow. Biceps problems in the elbow predominantly affect the distal tendon of the biceps at the point where it inserts on bone. Patients often complain of pain when there are degenerative changes with tendinopathy and in some cases acute pain and shortening of the muscle when the attachment ruptures.
The triceps muscle originates around the shoulder and attaches distally at the olecranon, which is a part of the ulna bone in the forearm. The triceps is the extensor of the elbow and problems typically occur around the insertion of the tendon into the bone.
What are the symptoms of biceps or triceps tendinopathy?
The main symptoms of tendinopathy are characterised by pain around the affected area, often related to sports and following periods of training. Acute or chronic ruptures of the biceps can lead to a classic deformity with the biceps retracting up the arm and bulging. Triceps ruptures are less common but can present in a similar way. There is usually a clear history of a pop and associated weakness, pain and bruising.
How is it diagnosed?
It is diagnosed by taking a careful history and performing a detailed examination as the diagnosis is usually clinical. However, ultrasound and MRI can also be used to assess for tears and demonstrate the amount of retraction of the muscle. These scans are also useful to demonstrate Tendinopathy and to exclude associated injuries.
How is it treated?
Treatment begins with symptomatic management using pain killers and a sling. The functional demands of the patient, including their chosen sports and occupation will help to guide treatment options.
In cases of chronic tendinopathy activity modification and physiotherapy, working on eccentric exercises can be successful.
Ultrasound-guided injections can be helpful both diagnostically and therapeutically but can potentially increase the risk of rupture.
Operative treatment will be guided by severity, patient preferences and symptoms. Open repair of acute triceps or biceps ruptures should be performed semi-urgently to prevent significant retraction and the need for grafting or the inability to repair
These operations can lead to restoration of function and an earlier return to sports and normal daily activities.