Adam asked the Guru about his bicep tendon impingement

April 17, 2014

For 2 years now I’ve suffered pain in my left shoulder following an injury during a lat pulldown exercise at the gym. After various unsuccessful physiotherapy sessions, xrays and cortisone injections I’ve managed to isolate the pain as coming from an impinged bicep tendon leading into the shoulder joint. Are there any specific treatments for this other than surgery? Would electroshock therapy work?

April 17, 2014

Hi Adrian Yup – lots.

Just because Physio has failed, it doesn’t mean you’ve failed at Physio.

First up is not confirming that it is LHB (however easily done though a variety of tests. Ludlingtons is perhaps the easiest, but by no means conclusive) but why you have an ongoing impingement. It may be due to a change in your boney anatomy – unlikely due to your X-ray being normal (?).

It may also be due to a change in functional space where the tendon sits. Biceps does sit alone, but the rest of the cuff all interdigitate – so where you feel it does not necessarily mean where the problem lies.

The change of space but can be either due to a really stiff mid back causing the shoulder blade and shoulder to sit in the wrong place and impinge. It can also be due to poor muscle control around the rotator cuff itself and it can also be LHB doing far too much because your shoulder has too much relative movement in all directions.

These are (some) of the causes and need to be nutted out before trying anything else.

ESWT does have a tiny place to play with a tiny number of people – but long term studies are pretty grim.

Good luck The Guru Six Physio

​Adrian replied:

thank you very much for this assessment. I did receive x-ray, MRI and ultrasound scans but nothing could be found except for an inflammation of the bicep tendon and some light fluid build up. I was advised that the next step would be surgery, though still being in recovery from my second meniscus surgery I’d like to avoid more surgery at all costs! I will avoid ESWT then and perhaps book a consultation with Six Physio.

The Guru responded:

Clinically – and more importantly functionally, fluid around your LHB occurs because the joint moves too much.

Gravity try’s to pull your arm out of your shoulder socket. Biceps therefore becomes more active to try to decrease the effect of gravity – it gets frazzled (it’s not meant to work like this) and swells. 

Why you’ve got a possible multi direction instability is the question. If this is true (and it’s a big if) then surgery is not the option needed – great rehab is. 

Keep in touch.

The Guru

Guru Responded

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