From the Guidelines
Biceps tenosynovitis and supraspinatus tendinosis are two distinct conditions affecting the shoulder, with biceps tenosynovitis being an inflammatory condition of the biceps tendon sheath and supraspinatus tendinosis being a degenerative condition of the supraspinatus tendon in the rotator cuff.
Definition and Diagnosis
Biceps tenosynovitis is characterized by inflammation of the sheath surrounding the biceps tendon, typically causing pain and swelling in the front of the shoulder that worsens with overhead activities or lifting 1. Supraspinatus tendinosis, on the other hand, is a degenerative condition affecting the supraspinatus tendon in the rotator cuff, characterized by microscopic tears and tissue breakdown rather than inflammation, often resulting in shoulder pain when raising the arm 1.
Treatment and Management
Treatment for both conditions typically includes rest, ice, anti-inflammatory medications like ibuprofen (400-800mg three times daily with food for 1-2 weeks), and physical therapy focusing on gentle stretching and strengthening exercises 1. For immediate relief, applying ice for 15-20 minutes several times daily and temporarily avoiding activities that cause pain is recommended.
- Key treatment considerations:
- Rest and avoidance of aggravating activities
- Ice application for pain relief
- Gentle stretching and strengthening exercises
- Anti-inflammatory medications for pain management
Diagnostic Imaging
Diagnostic imaging such as MRI or ultrasound may be necessary to confirm the diagnosis, especially if the diagnosis remains unclear after physical examination and initial treatment 1.
- Imaging options:
- MRI shoulder without contrast
- Ultrasound shoulder
- CT shoulder without contrast (less commonly used)
Prevention and Recurrence
These conditions often develop from repetitive overhead motions, poor shoulder mechanics, or age-related degeneration, with proper treatment addressing both pain management and the underlying biomechanical issues to prevent recurrence 1. It is essential to address the underlying causes of these conditions to prevent recurrence and promote long-term recovery.
From the Research
Biceps Tenosynovitis
- Biceps tenosynovitis is inflammation of the tendon around the long head of the biceps muscle 2
- It is commonly accompanied by rotator cuff tears or SLAP (superior labrum anterior to posterior) lesions 2
- Patients with biceps tenosynovitis usually complain of a deep, throbbing ache in the anterior shoulder 2
- Repetitive overhead motion of the arm initiates or exacerbates the symptoms 2
Supraspinatous Tendinosis
- Supraspinatous tendinosis is a common clinical problem that causes functional and labor disabilities in the population 3
- It is the most frequent cause of shoulder pain 3
- Chronic supraspinatus tendinopathy may be frequently associated with the affectation of the long head of the biceps tendon (LHBT) 3
- The percentage of associated lesions of LHBT and supraspinatus tendon is between 78.5% and 22% 3
Relationship between Biceps Tenosynovitis and Supraspinatous Tendinosis
- There is an epidemiological relationship between the chronic pathology of the supraspinatus tendon and the long head of the biceps tendon 3
- Some authors confirm the existence of an anatomical and functional relationship between the long head of the biceps tendon and the supraspinatus tendon 3
- Rotator cuff injury and its size are risk factors for high-grade injuries to the long head of the biceps tendon 4
- Pain at the anterior shoulder region during palpation of the intertubercular groove of the humerus may be related to high-grade lesions to the long head of the biceps 4