Biceps Tendinitis

The Problem

Biceps tendinitis is an inflammatory condition of the long head of the biceps (actually the biceps brachii) muscle.  The biceps runs along the front of the arm and the long head connects to the top of the shoulder.  Although the tendon can be injured by direct trauma, biceps tendinitis most often occurs along with other problems of the shoulder, including rotator cuff injuries, shoulder impingement, shoulder instability or arthritis of the shoulder joint.

Aging and the general process of daily wear and tear gradually weaken the tendon and can result in inflammation.  The problem can be worsened by repetitive motions or by overuse, particularly in athletes such as pitchers, tennis players, rowers and gymnasts.

The problem may present with pain in the front of the shoulder, particularly with lifting or overhead activities.  Pain can also be more widespread throughout the shoulder or vague and hard to pinpoint.

Diagnosis

The diagnosis is generally made through history and physical examination.  Localized tenderness may be found over the tendon or pain may be produced with special physical exam tests that stress the tendon.  Physical examination also serves to determine whether associated problems, like rotator cuff tears, labral tears or shoulder instability are present.

Treatment

There are multiple treatment options that are often carried out in stages.  Non-invasive treatment, such as ice or non-steroidal anti-inflammatory medications can decrease pain and inflammation.  Activities or motions that provoke pain should be avoided.

Anti-inflammatory treatments can be carried out in physical therapy.  Therapeutic exercise helps to restore lost range of motion and strengthens and stabilizes muscles throughout the shoulder.  This type of therapy can be carried out as pain and inflammation subside.

An injection of steroid, with or without local anesthetic, can be performed around the long head of the biceps to help speed resolution of the tendinitis if it has not responded to other measures.  Injections are sometimes performed to permit a more aggressive rehabilitation program.

Surgical treatment is considered if pain does not resolve with non-surgical methods, or if other shoulder problems, such as rotator cuff tear, shoulder instability or severe impingement are present.