What Is Biceps Tendonitis?
Biceps tendonitis is inflammation or irritation of the biceps tendon at the shoulder. The long head of the biceps runs through a groove at the front of your shoulder, making it vulnerable to injury with overhead and lifting activities.
Anatomy
The biceps has two heads:
**Long head:** Attaches to the top of the shoulder socket (labrum), runs through the shoulder joint**Short head:** Attaches to the coracoid process of the scapulaMost biceps tendonitis involves the long head where it passes through the bicipital groove.
What Causes It?
Overuse
Repetitive overhead movementsLifting with poor formThrowing sportsSwimmingRacquet sportsAssociated Conditions
Biceps tendonitis rarely exists alone. It's often associated with:
Rotator cuff problems (very common)Shoulder impingementLabral tears (SLAP lesions)InstabilityContributing Factors
Age (degeneration over time)Poor postureMuscle imbalancesSudden increase in activityPrior shoulder injurySymptoms
Classic Presentation
Pain at front of shoulderTender in bicipital groovePain with overhead reachingPain lifting objectsAching after activityPain reaching behind backWhat Makes It Worse
Overhead pressingCarrying heavy objectsTurning palm up against resistanceReaching back (like fastening bra)Lying on affected sideMay Also Feel
Clicking or snapping at front of shoulderWeakness with liftingRadiating pain to bicepsDiagnosis
Physical Exam
Speed's test:
Resist shoulder flexion with arm straight, palm upPositive if reproduces painYergason's test:
Resist supination and elbow flexionPain at bicipital groove = positivePalpation:
Tenderness directly over bicipital grooveImaging
X-rays:
Usually normalRule out other issuesMRI:
Shows tendon inflammation, partial tearsEvaluates rotator cuff and labrumUltrasound:
Dynamic evaluationCan see tendon inflammationCost-effectiveTreatment
Rest and Activity Modification
Avoid:
Overhead liftingHeavy lifting with arms extendedSleeping on affected sideContinue:
Light activity within toleranceDaily activities as ableIce
15-20 minutes after activityReduces inflammationNSAIDs
Help with pain and inflammationShort-term usePhysical Therapy
Key focus areas:
Rotator cuff strengthening:
External rotationRows with retractionEssential for shoulder mechanicsScapular stabilization:
Lower trapezius strengtheningSerratus anterior workFoundation for shoulder healthBiceps stretching:
Arm behind back, palm outGentle stretch at front of shoulderPosture correction:
Address rounded shouldersImprove thoracic extensionExercises
External rotation:
Band or dumbbellElbow at side3 sets of 15Scapular retraction:
Squeeze shoulder bladesHold 5 seconds15 repsRows:
Focus on scapular movementDon't shrug3 sets of 12Sleeper stretch (internal rotation):
Lie on affected sidePush forearm down gentlyImproves posterior capsule mobilityInjections
When considered:
Failed 4-6 weeks conservative treatmentSignificant painCorticosteroid injection:
Into bicipital grooveReduces inflammationMay provide lasting reliefLimit repeat injections (tendon weakening)Surgery
Rarely Needed
Most biceps tendonitis resolves with conservative treatment.
Indications
Failed 3-6 months conservative treatmentSignificant partial tear or full tearAssociated labral tear requiring repairOptions
Biceps tenodesis:
Reattach tendon lower on armMost common procedureBiceps tenotomy:
Release tendon (for older, less active patients)May result in "Popeye" bulge but usually painlessRecovery
Sling 2-4 weeksGradual return to activitiesFull recovery 3-4 monthsPrevention
Maintain Shoulder Balance
Strong rotator cuffGood scapular controlAdequate flexibilityProper Technique
Lift with good formDon't overload shouldersProgress graduallyPosture
Avoid prolonged forward shoulder positionTake breaks from desk work
Biceps tendonitis is usually part of a bigger shoulder picture. Treating just the biceps without addressing rotator cuff strength, scapular stability, and posture won't give lasting results. Fix the mechanics, and the biceps tendon usually calms down.