Biceps tendonitis occurs when the long head of the biceps tendon becomes red and swollen, causing pain and potentially leading to other issues. Learn about the anatomy of your shoulder, what causes biceps tendonitis, and how our experts treat the condition at Sports Med London.
Basic Shoulder Anatomy
It is easier to understand biceps tendonitis when you know the basic anatomy of the shoulder. The ball-and-socket joint where your upper arm meets your upper body is made up of three bones. They are the:
- Collarbone (clavicle)
- Shoulder blade (scapula)
- Upper arm bone (humerus)
The glenoid is the rounded socket into which the head of your upper arm bone fits. A soft and lubricating yet protective cartilage disc (the labrum) lines the glenoid. The rotator cuff is made up of several muscles and tendons that keep your arm in the centre of the socket. The rotator cuff also covers the head of your upper arm bone and attaches it to your shoulder blade.
The biceps muscle is in the front of your upper arm bone, to which it is attached by two tendons. The long head attaches to the glenoid, and the short head attaches to bump on the shoulder blade (the coracoid process).
The biceps’ long head runs from the biceps anchor in the glenoid, through the shoulder joint (glenohumeral), and down the bicipital groove before it becomes the muscle.
Causes And Symptoms
Biceps tendonitis, or the inflammation of the biceps tendon, can happen as a result of age, a fall, or lifting heavy loads repetitively. The condition also can occur if bone spurs in the bicipital groove pinch the tendon. Common symptoms include:
- Pain in the front of your shoulder
- Occasional pain when you bend your elbow with the palm of your hand facing up
- A catching feeling when you bend your elbow
Diagnosis And Treatment
Our specialists will ask you about your history with the condition, and they will perform a physical examination as well as a dynamic ultrasound scan. If they suspect you may have other shoulder injuries, they will send you for an MRI scan.
Non-surgical treatment usually includes:
- Painkillers (analgesia)
- Avoiding heavy lifting while recovering
- Ultrasound guided local anaesthetic and cortisone injections
Our specialists usually recommend surgical treatment for biceps tendonitis if non-surgical methods do not work, and the symptoms continue. Surgery may involve removing the swollen or damaged part of the tendon or cutting and reattaching the tendon to another location.
The surgery may be keyhole (arthroscopic) or through small cuts (mini-open), and it may be performed at the same time as a rotator cuff repair, if required. You will begin a tailored physiotherapy programme under the surgeon’s supervision following surgery.
What is biceps tendonitis?
The long head of biceps follows a tortuous route from the biceps anchor in glenoid labrum through the glenohumeral (shoulder joint) and down a groove (bicipital groove) before becoming the biceps muscle. The tendon can be inflamed or damaged (degenerate) anywhere along its course causing pain in the front of the shoulder. It is often associated with rotator cuff pathology including tears and impingement.
What causes biceps tendonitis?
It can occur with repetitive loads such as heavy lifting, following a fall or simply with age. It can occur with bone spurs within the bicipital groove which pinch the tendon.
What are the symptoms of biceps tendonitis?
Typically patients present with pain in the front of the shoulder, occasionally a feeling of catching and sometimes pain when bending the elbow (flexing) with the palm facing up (forearm supinated).
How is biceps tenonitis diagnosed?
This is based on a history, physical examination and a dynamic ultrasound scan. An MRI scan may be useful in excluding other injuries.
How is biceps tenonitis treated?
Initially analgesia, rest and physiotherapy. Avoiding lifting coupled with physiotherapy aimed at optimising shoulder movements and placing less strain on the biceps tendon are associated with good outcomes.
Surgery is indicated for persisting symptoms and failed conservative treatment. It may also be performed in conjunction with a rotator cuff repair if present. Surgery may involve either cutting the inflamed or degenerate/party torn tendon (tenotomy) or cutting it and reattaching it to a different location (tenodesis). Both have fairly similar outcomes and can be performed either arthroscopically (keyhole) or through small incisions (mini-open).
Following surgery, a rehabilitation program with physiotherapy is commenced to help you return to your normal day to day activities. The progress of this is dictated by patients meeting milestones and is run under the supervision of the surgeon and specially trained physiotherapist.