Biceps tendinitis is an inflammation or irritation of the biceps tendon. There are two ‘cords’ of the bicep, called the long head and short head. The long head of the biceps tendon, this strong, cord-like structure connects the biceps muscle to the bones in the shoulder. The long head is more likely to be the source of pain in bicep tendonitis.

Pain in the front of the shoulder and weakness are common symptoms of biceps tendinitis. They can often be relieved with rest and medication.

Description

Biceps tendonitis is inflammation of the long head of the biceps tendon. In its early stages, the tendon becomes red and swollen. As tendinitis develops, the tendon sheath (covering) can thicken. The tendon itself often thickens or grows larger. This can progress from acute pain to chronic pain.

The tendon in these late stages is changed due to the inflammation. Occasionally, the damage to the tendon can result in a tendon tear, and then deformity of the bicep muscle and arm (a “Popeye” bulge in the upper arm).

Biceps tendinitis usually occurs along with other shoulder problems. In most cases, there is also damage to the rotator cuff tendon. Other problems that often accompany biceps tendinitis include:

  • Arthritis of the shoulder joint
  • Tears in the glenoid labrum
  • Chronic shoulder instability (dislocation)
  • Shoulder impingement
  • Other diseases that cause inflammation of the shoulder joint lining
Cause

In most cases, damage to the biceps tendon is due to a lifetime of normal activities. As we age, our tendons slowly weaken with everyday wear and tear. This degeneration can be worsened by overuse — repeating the same shoulder motions over and over again.

Many jobs and routine chores can cause overuse damage. Sports activities — particularly those that require repetitive overhead motion, such as swimming, tennis, and baseball — can also put people at risk for biceps tendinitis.

Repetitive overhead motion may play a part in other shoulder problems that occur with biceps tendinitis. Rotator cuff tears, osteoarthritis, and chronic shoulder instability are often caused by overuse.

Symptoms
  • Pain or tenderness in the front of the shoulder, which worsens with overhead lifting or activity
  • Pain or achiness that moves down the upper arm bone
  • An occasional snapping sound or sensation in the shoulder
  • Decreased bicep strength
Treatment

Your orthopedic surgeon will work carefully to identify any other problems in your shoulder and treat them along with your tendinitis.
Nonsurgical Treatment
Biceps tendinitis is typically first treated with simple methods.

  • Rest. The first step toward recovery is to avoid activities that cause pain.
  • Ice. Apply cold packs for 20 minutes at a time, several times a day, to keep swelling down. Do not apply ice directly to the skin.
  • Nonsteroidal anti-inflammatory medicines. Drugs like ibuprofen and naproxen reduce pain and swelling. Like any over the counter medication, please read and follow the label. If you have a history of stomach ulcers, bleeding ulcers or heart conditions, these medications might not be right for you.
  • Physical therapy. Specific stretching and strengthening exercises can help restore range of motion and strengthen your shoulder. This should be completed with the help of a physiotherapist.

Injections may be beneficial for this condition. They may include:

  • Cortisone (Corticosteroid)
  • Platelet Rich Plasma (PRP)
  • Prolotherapy
  • Botox
  • Trigger Point Injections

Surgical Treatment
If your condition does not improve with nonsurgical treatment, your doctor may offer surgery. Surgery may also be an option if you have other shoulder problems.

Surgery for biceps tendinitis is usually performed arthroscopically. This allows your doctor to assess the condition of the biceps tendon as well as other structures in the shoulder.

During arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments.

  • Repair. Rarely, the biceps tendon can be repaired where it attaches to the shoulder socket (glenoid). This is mostly done for patients with a complete bicep tear.
  • Biceps tenodesis. In some cases, the damaged section of the biceps is removed, and the remaining tendon is reattached to the upper arm bone (humerus). This procedure is called a biceps tenodesis. Removing the painful part of the biceps usually resolves symptoms and restores normal function.
  • Tenotomy. In severe cases, the long head of the biceps tendon may be so damaged that it is not possible to repair or tenodese it. Your surgeon may simply elect to release the damaged biceps tendon from its attachment. This is called a biceps tenotomy. This option is the least invasive, but may result in a permanent Popeye bulge in the arm.