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Shoulder

Biceps Tendinitis

Biceps tendinitis (also called bicipital tendinitis) is a common cause of shoulder pain resulting from inflammation or irritation of the long head of the biceps tendon. This condition is often seen in athletes and active individuals, especially those who perform repetitive overhead motions such as throwing, swimming, or lifting.

Although biceps tendinitis can cause discomfort and limit function, it typically responds well to non-surgical treatments. In more severe or chronic cases, surgery may be required to alleviate pain and restore strength.

The biceps brachii muscle, commonly known as the biceps, is located at the front of the upper arm. It has two tendons that attach it to the shoulder:

  • Long head of the biceps tendon: Runs through the front of the shoulder joint and attaches to the top of the shoulder socket (glenoid) inside the joint.
  • Short head of the biceps tendon: Attaches to a bony projection on the shoulder blade called the coracoid process.

The long head of the biceps tendon travels through a groove in the upper part of the humerus (arm bone) called the bicipital groove, where it is held in place by a sheath and ligament. This tendon is more prone to irritation and inflammation, especially when the shoulder is used repetitively or is unstable.

Biceps tendinitis often occurs alongside other shoulder issues, such as rotator cuff tears, shoulder impingement, or labral tears.

Common symptoms include:

  • Pain in the front of the shoulder, especially with lifting, pulling, reaching overhead or away from the body.
  • Tenderness over the bicipital groove, which is located in the front of the shoulder.
  • Aching or throbbing pain that worsens with activity.
  • Snapping or popping sensation in the shoulder (in cases of tendon instability or rupture).
  • Pain at night, which may interfere with sleep.

In some cases, if the tendon is severely degenerated or ruptures, patients may experience a sudden “pop” followed by a noticeable bulge in the upper arm—commonly referred to as a “Popeye deformity.”

Biceps tendinitis typically develops from overuse, degeneration, or shoulder instability. Common causes include:

Repetitive Overhead Activity

  • Sports like baseball, tennis, swimming, or volleyball.
  • Jobs that involve overhead lifting or repetitive shoulder use.

Age-Related Degeneration

  • Tendons lose elasticity and become more prone to wear and tear as people age.

Shoulder Instability or Impingement

  • Abnormal shoulder movement can pinch or strain the biceps tendon.
  • Often associated with rotator cuff disorders or bone spurs.

Acute Injury

  • A sudden heavy load or trauma to the arm can strain or rupture the tendon.

  • Age over 40
  • Poor posture
  • Weak shoulder or scapular muscles
  • Previous shoulder injuries
  • Overhead athletes

Biceps tendinitis is often diagnosed in combination with other shoulder problems like rotator cuff tendinopathy or labral tears.

Diagnosis of biceps tendinitis involves:

Physical Examination

  • Tenderness over the bicipital groove.
  • Special tests may reproduce pain when the arm is lifted or rotated.

Imaging

  • X-rays: While they don’t show tendons, they help rule out other causes like arthritis or bone spurs.
  • MRI: These can visualize the tendon and detect inflammation, tears, or dislocation of the tendon.

Most cases of biceps tendinitis respond well to non-surgical management. Common treatments include:

Rest and Activity Modification

  • Avoid overhead or strenuous activities that aggravate pain.
  • Temporarily stop sports or lifting until symptoms improve.

Ice Therapy

  • Apply ice packs to the front of the shoulder for 15–20 minutes several times a day to reduce inflammation.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

  • Over-the-counter medications like ibuprofen or naproxen can relieve pain and reduce inflammation.

Physical Therapy

Focuses on:

  • Stretching and strengthening the shoulder and scapular muscles.
  • Improving posture and biomechanics to reduce stress on the tendon.
  • Gradual return to activities with correct technique.

Corticosteroid Injections

  • A steroid injection into the bicipital groove and biceps sheath can reduce inflammation and pain.
  • Often used if pain persists despite rest and therapy.
  • Should be used cautiously, as repeated injections can weaken the tendon.
  • Often done under ultrasound guidance

With consistent treatment, symptoms often improve within 6–8 weeks, but full recovery may take several months.

Surgery is usually considered when:

  • Nonoperative treatment fails after 3–6 months.
  • The tendon is partially or completely torn with no relief from conservative therapy
  • There is significant shoulder pain and weakness affecting quality of life.

The most common surgical procedures include:

Biceps Tenotomy

  • The long head of the biceps tendon is released from its attachment inside the shoulder joint.
  • This reduces pain and inflammation but may lead to a visible muscle bulge (“Popeye deformity”) in some patients.
  • Often chosen for older, less active individuals or those with minimal cosmetic concerns.

Biceps Tenodesis

  • The biceps tendon is detached from its original position and reattached to the humerus (arm bone) in a different location away from the location of pain
  • This preserves the biceps muscle contour and reduces the risk of muscle cramping or cosmetic deformity.
  • Often performed in younger, active patients or athletes.
  • Can be done arthroscopically or with a small open incision.

Combined Procedures

  • If biceps tendinitis is associated with other conditions (like rotator cuff tears), the surgeon may address both issues during the same surgery.

Nonoperative Recovery

  • Most patients recover with physical therapy, anti-inflammatory treatment, and activity modification.
  • Success rates for conservative treatment range from 70–90%.

Post-Surgical Recovery

  • Tenotomy recovery is relatively quick, with return to normal activity in 4–6 weeks.
  • Tenodesis recovery typically involves:
    • Sling use for 2–4 weeks.
    • Gradual return to light activity by 6 weeks.
    • Full return to sports or heavy lifting around 3–4 months.
  • Physical therapy is important after both procedures to regain range of motion and strength.

Surgical Outcomes

  • Most patients report significant pain relief and improved function after either tenotomy or tenodesis surgery.
  • Tenodesis has a lower risk of cramping and cosmetic changes compared to tenotomy.

  • Warm up before activity and stretch regularly.
  • Strengthen rotator cuff and shoulder blade muscles.
  • Avoid repetitive overhead motions or poor lifting technique.
  • Use proper posture during work and exercise.
  • Gradually increase activity intensity to avoid overuse injuries.

You should consult a healthcare provider if:

  • Shoulder pain persists for more than a few weeks.
  • Pain limits your ability to perform normal activities or sleep.
  • You experience sudden arm weakness or a “pop” in the shoulder.
  • A noticeable bulge or deformity develops in the upper arm.

Biceps tendinitis is an inflammation of the long head of the biceps tendon, typically caused by overuse, degeneration, or shoulder instability. It presents with pain in the front of the shoulder and weakness during lifting or rotation.

Most cases improve with nonoperative treatment, including rest, physical therapy, and medications. For those who don’t respond to conservative care or who have significant tendon damage, surgical options like tenotomy or tenodesis offer effective relief.

With early diagnosis and appropriate management, patients can expect to return to their normal activities and maintain long-term shoulder function.

At a Glance

Dr. Hasani Swindell

  • Fellowship-Trained Sports Medicine Specialist
  • Board-Certified Orthopedic Surgeon
  • Summa Cum Laude Graduate from the University of Pittsburgh
  • Medical Degree from Columbia University
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