Biceps Tendonitis/Tendinopathy

Long Head Biceps Inflammation

Biceps tendinopathy (or biceps tendonitis) is inflammation or more likely degeneration of the long head of the biceps muscle causing pain at the front of the shoulder. It is not a particularly common injury, but excessive weight training or overuse is a potential cause. 

On this page:

  • Symptoms
  • Causes & anatomy
  • Treatment

Symptoms of biceps tendinopathy

Symptoms of biceps tendinopathy/tendonitis include pain and inflammation at the front of the shoulder. Pain may develop gradually over time or may occur from a previous acute biceps tendon strain which has failed to heal properly. Pain and tenderness will be felt when pressing in (palpating) the front of the shoulder over the tendon of the long head of the biceps muscle.

Specific tests a professional therapist might use to help diagnose an injury to the biceps tendon include the 'uppercut' test and resisted shoulder flexion. The uppercut test involves the patient performing an uppercut punch while the therapist resists the upwards movement. This test is positive if pain is felt at the front of the shoulder. There may also be a 'pop' over the front of the shoulder.

Resisted shoulder flexion is done by getting the patient to lift a straight arm up in front of them against resistance. Again, if the pain is reproduced at the front of the shoulder then a biceps tendon injury is indicated. Biceps tendinopathy is not a particularly common shoulder injury and it is often misdiagnosed when rotator cuff injury may be the real cause of injury.

Biceps tendinopathy causes & anatomy

The biceps brachii muscle is the large muscle at the front of the upper arm which bends (flexes) the elbow when it contracts. The muscle splits into two tendons at the shoulder, one shorter tendon, and a longer tendon which runs over the top of the humerus bone (upper arm) and attaches to the top of the shoulder blade (scapula bone). Inflammation of this tendon can occur through overuse, however, the term tendinopathy is probably a more accurate one to use because it describes other pathologies including degeneration of the tendon

Acute inflammation can occur, but if the injury is a more long term, chronic injury then degeneration (fraying) of the tendon is more likely as opposed to the presence of acute inflammatory cells if the injury is a few days old.

Although this is not a particularly common cause of pain at the front of the shoulder, it is more likely to occur in sports such as swimming, rowing, golf and in particular weight training. The bench press exercise and dips exercises put a great deal of load through the long head of the biceps muscle.

Biceps tendinopathy treatment

Although there is no specific treatment that has been proved to cure degeneration or fraying of the tendon, the aim is to reduce painful symptoms and then gradually increase the load through the tendon to a point where normal sports activities can be resumed.

What can the athlete do?

Rest until there is no pain. Apply ice to ease pain and inflammation. Ice can be applied for 10 to 15 minutes every hour initially reducing the frequency as symptoms improve. See a sports injury professional.

What can a sports injury specialist do?

A doctor can prescribe anti-inflammatory medication such as ibuprofen. A sports injury professional practitioner can demonstrate stretching and strengthening exercises as part of a full rehabilitation program. They may apply sports massage to the muscle itself or in chronic cases cross friction massage to the tendon may be beneficial.

This article has been written with reference to the bibliography.