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Shoulder

Biceps Tendonitis

What is Biceps Tendonitis?

Biceps tendonitis is a condition in which the tendon of the biceps muscle becomes inflamed or irritated, most commonly where it passes through the front of the shoulder. This tendon—known as the long head of the biceps tendon—helps stabilize the shoulder and assists in lifting and rotating the arm.

When the tendon becomes overloaded or irritated from repetitive use, it can cause pain in the front of the shoulder, weakness, and difficulty with overhead or lifting motions. Biceps tendonitis often occurs alongside other shoulder problems such as rotator cuff tendinitis, impingement, or labral tears.

The biceps muscle has two tendons that attach at the shoulder:

  • The long head, which runs through a groove in the upper arm bone (bicipital groove) and attaches to the top of the shoulder socket (glenoid labrum).
  • The short head, which attaches to the coracoid process of the shoulder blade.

The long head of the biceps tendon is the one most frequently affected by inflammation or degeneration. It travels through a tight tunnel inside the shoulder, where friction or compression from repetitive motion can cause irritation.

Over time, this can lead to tendinitis (inflammation), tendinopathy (degenerative changes), or even partial tearing of the tendon.

Biceps tendonitis is a common source of anterior shoulder pain, particularly among:

  • Athletes who perform repetitive overhead motions—such as baseball pitchers, swimmers, tennis players, and volleyball players.
  • Manual laborers who lift, push, or pull frequently.
  • Middle-aged adults with rotator cuff disease or shoulder impingement.

It is also a frequent finding in patients with shoulder instability or labral (SLAP) tears, since the biceps tendon anchors into the top of the labrum.

Biceps tendonitis typically develops from repetitive microtrauma rather than a single injury. Common causes include:

  • Overuse or repetitive overhead activity, which places excessive tension on the tendon.
  • Poor posture or shoulder mechanics, leading to increased friction in the bicipital groove.
  • Rotator cuff weakness, which alters shoulder alignment.
  • Age-related degeneration, where the tendon loses elasticity and becomes more prone to irritation.
  • Previous shoulder injuries such as impingement or labral tears that change shoulder biomechanics.

Common symptoms include:

  • Pain in the front of the shoulder, often described as a deep, dull ache.
  • Tenderness over the bicipital groove, located just in front of the shoulder joint.
  • Pain that worsens with overhead motion or lifting.
  • Clicking or snapping sensation in the shoulder.
  • Weakness or fatigue when bending the elbow or rotating the arm.

If the tendon partially tears or ruptures, patients may notice a sudden “pop” followed by bruising and a bulge lower in the arm, known as a “Popeye deformity.”

Diagnosis begins with a thorough history and physical examination by Dr. José Vega, Cleveland’s trusted orthopedic shoulder specialist.

Physical exam findings:

  • Tenderness over the front of the shoulder.
  • Pain with resistance during elbow flexion or supination (rotating the palm upward).
  • Positive Speed’s or Yergason’s test, which reproduce pain over the biceps tendon.

Imaging studies help confirm the diagnosis and rule out other shoulder problems:

  • Ultrasound: Can identify tendon thickening, inflammation, or partial tears.
  • MRI: Provides detailed imaging of the biceps tendon, rotator cuff, and labrum.
  • X-rays: May show bone spurs or changes that contribute to impingement.

Because biceps tendonitis often occurs alongside other shoulder conditions, a comprehensive evaluation ensures accurate diagnosis and optimal treatment.

Treatment aims to relieve pain, reduce inflammation, and restore normal shoulder mechanics. Most patients improve with nonsurgical care.

Nonsurgical Treatment

  • Rest and activity modification: Avoid repetitive overhead movements or heavy lifting that aggravate symptoms.
  • Anti-inflammatory medications (NSAIDs): Help control pain and inflammation.
  • Ice therapy: Applied several times daily for 15–20 minutes.
  • Physical therapy: Focuses on restoring shoulder motion, strengthening the rotator cuff and scapular stabilizers, and correcting posture.
  • Corticosteroid injections: Targeted injections into the biceps tendon sheath can reduce inflammation and provide short-term pain relief.
  • Biologic injections (PRP): Platelet-rich plasma may promote tendon healing in cases of chronic tendinopathy.

With consistent treatment, most patients experience significant improvement within 6–8 weeks.

Surgical Treatment

Surgery is considered when pain persists despite at least 3–6 months of nonsurgical care or if the tendon is partially torn.

Biceps Tenotomy

  • The damaged portion of the tendon is released from its attachment, allowing it to retract slightly.
  • Provides excellent pain relief and rapid recovery.
  • May result in mild cosmetic “Popeye” deformity or occasional muscle cramping.
  • Typically recommended for older or lower-demand patients.

Biceps Tenodesis

  • The tendon is detached from its original attachment and reattached lower on the humerus.
  • Maintains muscle contour and strength while eliminating pain from the damaged tendon.
  • Ideal for younger, active patients or those performing heavy labor or sports.
  • Can be performed arthroscopically or through a small incision.

Recovery typically involves a sling for up to 6 weeks, followed by physical therapy to restore motion and strength. Most patients return to full activity within 3–4 months.

While not all cases can be prevented, you can reduce your risk by:

  • Maintaining strong rotator cuff and shoulder stabilizers.
  • Warming up properly before sports or weight training.
  • Avoiding repetitive overhead strain and excessive lifting.
  • Practicing proper form during exercises such as bench press or overhead press.
  • Addressing shoulder pain early to prevent progression to tendon degeneration or tearing.

Biceps tendonitis is a common cause of anterior shoulder pain caused by overuse, inflammation, or degenerative changes of the long head of the biceps tendon. With early diagnosis, personalized therapy, and, when necessary, advanced surgical techniques like biceps tenodesis, patients can achieve lasting pain relief and full return to activity. If you’re experiencing shoulder pain or think you may have injured your biceps tendon, contact Dr. José Vega’s office in Cleveland to schedule an evaluation today.

References

  1. Frost A, Zafar MS, Maffulli N. Tenotomy versus tenodesis in the management of pathologic lesions of the long head of the biceps brachii. Am J Sports Med. 2009;37(4):828–833.
  2. Braun S, Horan MP, Elser F, Millett PJ. Lesions of the biceps pulley. Am J Sports Med. 2011;39(4):790–795.
  3. Checchia SL, Doneux PS, Miyazaki AN, et al. Biceps tenodesis versus tenotomy for the treatment of lesions of the long head of the biceps tendon: a randomized prospective study. J Shoulder Elbow Surg. 2005;14(2):111–117.
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Dr. Jose Vega

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