A very common but missed cause of shoulder pain and limited motion is subluxation of the biceps tendon. That’s a mouth full. Let’s first look at the anatomy, symptoms and then how you might be able to tell if this could be your problem. Lastly, we will review possible treatment. First, the biceps muscle is a two headed muscle that is why it’s a “bi” –ceps instead of a monoceps or triceps muscle. And you’re right, there is not a muscle named Monceps.
The biceps attaches right in front of your elbow and at your shoulder at two different places. The shoulder and biceps can be injured from over throwing, lifting too much weight or lifting it incorrectly, such as an over swing of a club or a bat. The long head of the biceps has to go through a groove, a shallow canyon if you will, right at the front of the shoulder. Injury to the shoulder can make the ligament overlying this tunnel or groove lax and the tendon rides up on the side of the groove or canyon. When this happens it sets off a cascade of irritation, and then muscle imbalances that further derail good and normal motion eventually preventing you from doing what you like to do: swing a club, swim or do a pull up. Only in the most severe cases is surgery indicated and those are usually discovered quite quickly due to the amount of pain. The sneaky ones are the more mild biceps tendon problems that create chronic shoulder pain that prevents normal activities and can be misdiagnosed and treated as bursitis, tendonitis, impingement, ‘your just getting older” or good old Arthur (arthritis).
Symptoms of the biceps tendon being slightly out of groove usually will cause pain in the front of the shoulder with sometimes even a clunking sound or feeling. While only sometimes present, this symptom is the tendon shifting in and out of its groove. Sometimes the pain can be in the front of the arm (front side of the elbow) where the lower biceps attaches. Pain can also migrate to the back of the shoulder. You might feel pain only when doing the following or it may make the present pain worse: Throwing motions, bringing the shoulder in front of the body or above the head, doing a pull up, swimming or even just lying in bed. Here are some home tests that might be suggestive of biceps tendon problems:
1. With your elbow locked, lift your arm, palm up in front of you. Does this create pain? Can you lift a light (3-5 lbs.) weight? Does this feel weak or do you have pain in your shoulder?
2. With your elbow bent, place the palm of your hand on the opposite shoulder and now raise your elbow to the sky. Can you? Does it create pain?
If you have symptoms of pain, weakness or inability to move the arm, you may very well have a biceps problem. You certainly have a shoulder problem. We evaluate the shoulder with Chiropractic and Orthopedic testing. If we find the tendon has subluxated, we use manual techniques to get it back in the groove. We also use Neurokinetic therapy to evaluate what muscles are over-active and under-active thereby guiding us on what treatment, releases and exercises to use. Occasionally, an X-ray may be needed and on the rare occasion, an MRI to better evaluate. These problems are so common that I see at least one per week!
If you find that your shoulder is keeping you from doing the things you love to do, give our office a call. Let us examine you and see if we can help. Please check out this link for our YouTube on the shoulder.
Dr Steve Gradwohl