Bicep Tendonitis

What is bicep tendonitis?

Biceps tendonitis is a condition that occurs when you have inflammation in your upper biceps tendon. This tendon — also known as the long head of the biceps tendon — connects your biceps muscle to your shoulder blade bone. The condition can also occur at your elbow.

This type of tendonitis (also spelled tendinitis) is an overuse injury that often happens due to a repeated overhead motion. For instance, professional baseball players, swimmers, tennis players and golfers are at risk for tendonitis in their shoulders, arms and elbows. Tendonitis can also occur because of a sudden, serious load to the tendon.

Biceps tendinitis doesn’t typically occur alone. It most often happens alongside other shoulder issues, including:

• Shoulder arthritis.
• Dislocated shoulder.
• Shoulder impingement syndrome.

What does bicep tendonitis feel like?

If you have biceps tendonitis, you’ll have bicep pain or tenderness in the area in front of your shoulder. This pain may get worse if you continue to participate in physical activity or try to lift your arm over your head.

You may also have upper arm muscle pain that moves down your upper arm bone. Along with pain and tenderness, you may hear a snapping sound or feel a snapping sensation in your shoulder.

What causes biceps tendonitis?

Biceps tendonitis can happen with the wear and tear that you put on your tendons during your usual daily activities. As you get older, these tendons start to wear down and can get worse when you overuse them. When you use the same shoulder motions over and over again, the repeated wear and tear can lead to the condition.

Biceps tendonitis frequently affects athletes because of the repeated overhead motions they make in their sports. Baseball players, tennis players, golfers and swimmers are particularly at risk of developing the condition.

What are the risk factors for biceps tendonitis?

There are several risk factors for developing biceps tendonitis, including:

• Age.
• Repeated overhead motions in your daily activities.
• Participating in sports or other physical activities.
• Arthritis.
• Smoking.

What are the complications of biceps tendonitis?

Severe overuse of your biceps tendons can lead to complications, including biceps tears.

Bicep tendon tears

In cases of serious or constant overuse, a tendon may fray and eventually cause a bicep tear. A tendon can also tear as part of an injury, like moving or twisting your elbow or shoulder in an awkward way, or falling down with your arm outstretched. At the elbow, the bicep tendon most often tears while lifting a heavy object (for example, a couch or a refrigerator).

A bicep tendon tear can happen at either the shoulder or the elbow. A tear can also be complete (biceps tendon rupture) or partial. A biceps tendon rupture means the tendon has torn away from the bone.

Distal biceps tendon tears

While two tendons attach the biceps muscle to the bone at the shoulder, only one tendon attaches it to the elbow. This is called the distal biceps tendon.

Tears of the distal biceps tendon are unusual and most often result from an injury or lifting a heavy object. When this tendon tears, however, the tear is usually complete and the muscle is separated from the bone and retracted back. This causes weakness in powerful palm-up activities like tightening a screwdriver with the right hand.

How is biceps tendonitis diagnosed?

Your healthcare provider will ask about your medical history and symptoms. Then, they’ll perform a physical exam. During the exam, your provider will check the function of your biceps. They’ll also check your shoulder for:

• Range of motion.
• Strength.
• Signs of instability.

What tests will be done to diagnose this condition?

Your healthcare provider may request imaging tests to help them make a diagnosis. These tests may include:

• X-rays.
• Ultrasound.
• Magnetic resonance imaging (MRI).

What is the treatment for bicep tendonitis?

Treatment for biceps tendonitis typically starts with noninvasive (nonsurgical) methods like:

• Cold packs. Cold packs or ice can help reduce swelling and pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Medications like aspirin or ibuprofen can help relieve swelling and pain.
• Rest. It’s particularly important to avoid any heavy lifting, flexing at your elbow and over your head.
• Physical therapy. Your provider may refer you to a physical therapist to help your shoulder or elbow recover with biceps tendonitis exercises.
• Steroid injections. Your provider may give you a corticosteroid, which can help with pain relief, halt the inflammatory process and get your tendon back on a path of healing.

Surgical treatment

If noninvasive methods don’t help improve your condition, your healthcare provider may suggest surgery. Your provider will likely perform the surgery arthroscopically. That means they’ll insert a small camera (arthroscope) in your shoulder joint to take pictures, which will help them guide the procedure using small surgical instruments.

Surgical options may include:

• Biceps tenodesis. Your surgeon will remove the damaged section of your bicep and reattach the remaining tendon to your upper arm bone (humerus).
• Tenotomy. Your surgeon will release your damaged biceps tendon from its attachment.

Complications/side effects of the treatment

Overall, complication rates from surgery for biceps tendonitis are low. But surgery can sometimes lead to complications, including:

• Infection and/or bleeding at the surgical site.
• Stiffness.
• Bicep pain.
• Muscle spasms (muscle cramps).
• Cosmetic (“Popeye”) deformity (bulge in your arm).

How long does it take for bicep tendonitis to heal?

Recovery time for biceps tendonitis depends on the extent of your injury and method of treatment. With noninvasive treatment, your condition should improve within a few weeks.

If you have surgery, recovery time will take longer. Your healthcare provider will recommend you wear a sling anywhere from one to four weeks, depending on the surgery. You’ll also need physical therapy or some other type of rehabilitation. It may take three to four months for full recovery.

Can biceps tendonitis be prevented?

Because overuse causes most cases of tendonitis, the best treatment is prevention. It’s important to avoid or change the activities that cause the problem. When doing physical activities:

• Take it slowly at first and gradually build up your activity level.
• Limit the number of repetitions you do and the amount of force you use.
• Stop if you feel any unusual pain.

Be careful to avoid and then correct improper posture or poor technique in sports or work.

What can I expect if I have this condition?

If you have biceps tendonitis, you’ll feel pain and tenderness in your shoulder area. If simple measures like rest, pain relievers and ice don’t help improve your condition within a few weeks, your provider may recommend surgery.

Most people who get surgery for biceps tendonitis have good results. You should be able to regain your full range of motion and be able to move your arm without pain. If you play sports with lots of overhead motions, you may need to limit your activities after surgery.

When should I see my healthcare provider?

Many cases of biceps tendonitis will go away within a few weeks of simple measures, including rest, ice and NSAIDs. But if your pain makes it difficult to perform your usual daily activities and self-care hasn’t improved your condition, you should see your healthcare provider for further treatment.

You should also see your provider if pain continues to interfere with any overhead motions you make while playing sports. Also, call your provider if you experience any sharp, sudden pains or develop a bulge in your upper arm.

What questions should I ask my healthcare provider?

If you have biceps tendonitis, you may wish to ask your provider the following questions:

• What kind of treatment do you recommend?
• What else can I do for the pain?
• When can I return to my usual activities?
• How can I prevent this condition in the future?