Pain Management Procedures
Biceps Tendon Sheath Injection
Biceps Tendon Sheath Injection
What is it?
The long head of the biceps tendon runs through a groove at the front of the shoulder. Its sheath communicates with the shoulder joint. When the tendon or sheath is irritated, pain is often felt at the front of the shoulder and may worsen with lifting, reaching, or turning the palm upward. A tendon-sheath injection places medication around the tendon, not into the tendon fibers.
When may it be recommended?
The procedure may help diagnose or treat biceps tendinopathy or tenosynovitis when examination and imaging suggest that the biceps is a major pain source. It can be especially useful when MRI shows several abnormalities and the clinician needs to learn which one actually produces the symptoms.
What happens?
You usually lie on your back with the arm positioned to display the bicipital groove. Ultrasound identifies the tendon and guides a small needle into the surrounding sheath. Local anesthetic and often corticosteroid are injected while the clinician watches the medication spread around, rather than through, the tendon.
What should I expect?
Front-of-shoulder soreness can occur briefly. Avoid heavy pulling, lifting, or resistance exercise until the care team says it is safe. Immediate relief from anesthetic can support the diagnosis; steroid benefit may take several days.
Important risks
Potential complications include infection, bleeding, medication reaction, skin changes, temporary blood-sugar elevation, and tendon weakening or rupture. Direct injection into the tendon is avoided. Because the sheath connects with the shoulder joint, infection is an important but uncommon concern.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.