Biceps Tendinopathy: Causes & Advanced Treatments

Author: Mr Oliver Eaton BSc (Hons), PG.Cert – Orthopaedic Specialist
Reviewed by: Mr William Sharples BSc (Hons) – Pain Management Expert
Last Updated: September 2025

In this article, you will learn everything you need to know about Biceps tendinopathy and the most effective ways to treat it, including an advanced treatment called Prolotherapy.

Introduction

Biceps tendinopathy is a common cause of shoulder pain, especially in athletes, manual workers, and people who perform repetitive overhead activities. It refers to degeneration or inflammation of the biceps tendon, most often at the long head where it passes through the shoulder joint.

Common risk factors for biceps tendinopathy include repetitive overhead activity, increasing age, and participation in certain sports or occupations that place additional stress on the shoulder.

Early diagnosis and targeted treatment are essential for a full recovery and to prevent recurrence.1

Epidemiology and Demographics

Biceps tendonitis is a frequently encountered condition of the upper arm, particularly among individuals who regularly perform repetitive overhead motions. According to data published in the Journal of Shoulder and Elbow Surgery (J Shoulder Elbow Surg), the annual incidence of biceps tendonitis is estimated at 10-20 cases per 100,000 people. The condition is notably more prevalent in men than women, with the highest rates observed in those aged 40 to 60 years. Sports that involve throwing, such as baseball, tennis, and golf, as well as occupations requiring repetitive lifting or carrying, are associated with a higher risk of developing biceps tendonitis. This demographic trend highlights the importance of early recognition and intervention, especially in active populations and manual laborers, to prevent progression and long-term disability.

What Is Biceps Tendon Tendinopathy?

Biceps tendinopathy is a chronic condition involving the breakdown, thickening, or inflammation of the biceps tendon. Biceps tendinopathy includes both degenerative tendinopathy, which refers to chronic, age-related or degenerative changes with structural disorganization and myxoid degeneration, and biceps tendinitis, which is more related to acute or inflammatory processes. It can result from overuse, repetitive lifting, poor biomechanics, or age-related degeneration. The biceps muscle plays a crucial role in shoulder stability, arm movement, forearm supination, and elbow flexion. The long head of the biceps tendon is most commonly affected, but the short head or distal biceps tendon at the elbow can also be involved.2

Histopathology and Pathophysiology

The underlying changes in biceps tendonitis are characterized by a combination of tendinosis, inflammation, and degeneration within the biceps tendon. Repetitive mechanical stress on the tendon can cause microtrauma, leading to a cascade of inflammatory responses and eventual breakdown of the tendon’s collagen structure. Over time, this results in thickening, disorganization, and weakening of the tendon tissue, which can compromise its function and contribute to pain. The rotator cuff muscles play a vital role in stabilizing the shoulder joint, and dysfunction or weakness in these muscles can increase the strain on the biceps tendon, further exacerbating the condition. Advanced imaging techniques, such as magnetic resonance imaging (MRI) and ultrasound imaging, are invaluable tools for visualizing these pathological changes, allowing clinicians to assess the severity of tendon involvement and monitor the response to treatment.

Symptoms of Biceps Tendinopathy

Deep, aching pain at the front of the shoulder or upper arm; patient experiences pain during certain movements or palpation
Pain worsened by overhead activity or lifting
Tenderness over the biceps groove, especially at the affected tendon
Weakness or fatigue in the arm related to the affected tendon
Clicking, snapping, or catching sensation in the shoulder
Occasional swelling or visible changes in the upper arm, including loss of muscle bulk (in severe cases)

Related Conditions

Shoulder problems often coexist with or contribute to biceps tendinopathy. These may include rotator cuff tears, impingement syndrome, and labral injuries.

Biceps tendonitis rarely occurs in isolation and is often associated with other shoulder joint pathologies. Commonly, it coexists with rotator cuff tendinitis and rotator cuff tears, which can further compromise shoulder function and increase pain. Damage to the superior labrum, particularly superior labrum anterior-posterior (SLAP) lesions, is another frequent finding in patients with biceps tendon pathology. The superior labrum is a crucial structure that helps stabilize the shoulder socket, and injuries here can lead to persistent symptoms and functional limitations. Other related conditions include shoulder impingement syndrome, adhesive capsulitis, and glenohumeral arthritis. A comprehensive evaluation, including physical examination and advanced imaging, is essential to identify these associated conditions and guide an effective, individualized treatment plan.

Diagnosis and Rotator Cuff Assessment

Diagnosis is based on a physical exam, including inspection and palpation of the patient’s shoulder, medical history, and sometimes imaging (ultrasound or MRI) to assess the extent of tendon injury. Special tests, such as Speed’s or Yergason’s test, may be used to provoke symptoms and confirm the diagnosis. The anterior slide test is another maneuver used to assess labral pathology, particularly for superior labral lesions. These special tests often involve elbow flexion, with the elbow flexed and the forearm pronated, and may require that the patient stands for proper positioning. Imaging studies are important for evaluating the superior glenoid labrum, identifying superior labral lesions, and assessing the glenohumeral joint, humeral head, and surrounding soft tissue. Blood tests may be used to rule out other causes of shoulder pain. When interpreting imaging or exam findings, tendon tears are an important differential diagnosis to consider. Early diagnosis helps guide effective treatment and reduces the risk of chronic pain or tendon rupture.3

Complications and Comorbidities

If not properly managed, biceps tendonitis can result in significant complications. Chronic pain, reduced range of motion, and diminished strength in the affected arm are common outcomes of untreated or poorly treated cases. One of the most serious complications is biceps tendon rupture, where the tendon either partially or completely tears, often resulting in a noticeable deformity and substantial loss of function. This may require surgical intervention, especially in active individuals or those with significant disability. Additionally, comorbidities such as rotator cuff tears, shoulder instability, and cervical spine disorders can complicate the clinical picture, making diagnosis and management more challenging. Addressing these comorbidities is crucial for achieving optimal recovery and preventing recurrence of biceps tendon problems.

Treatments for Biceps Tendinopathy and Physical Therapy Options

Treatment depends on the severity and cause of the tendinopathy. Options include:

Rest and activity modification: Avoid activities that aggravate pain.
Ice and anti-inflammatory medications: Reduce pain and swelling.
Physical therapy: Restore flexibility, strength, and correct muscle imbalances.
Stretching and strengthening exercises: Target the biceps, rotator cuff, and supporting muscles.
Manual therapy: Relieve muscle tension and promote healing.
Gradual return to sport or work: Follow a structured rehabilitation plan to prevent re-injury.
Steroid injections and corticosteroid injections: For persistent symptoms, steroid or corticosteroid injections can be administered into the biceps tendon sheath. Accurate biceps tendon sheath injection into the tendon sheath is important for effective pain relief and to minimize complications.
Surgery: Surgical management may be considered for severe tendon ruptures or chronic cases unresponsive to conservative care. Specific procedures include biceps tenodesis and biceps tenotomy, which are performed to provide pain relief and address tendon instability or degeneration. Surgical management is typically performed by an orthopedic surgeon. After surgical repair, active elbow flexion should be avoided for a few weeks to protect the healing tendon.

Prolotherapy

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat biceps tendinopathy. Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits. Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with biceps tendinopathy. As prolotherapy is helping to treat the root cause of biceps tendinopathy, it is deemed to be a permanent fix, preventing the symptoms from returning.

Disclaimer: The information provided in this section is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Prolotherapy may not be suitable for everyone, and outcomes can vary. Always seek the guidance of a qualified healthcare professional regarding your specific medical condition or treatment options. Never disregard professional medical advice or delay seeking it because of information you have read here.

Advanced Treatments and Technologies

The management of biceps tendonitis has evolved with the introduction of advanced treatments and technologies aimed at enhancing tendon healing and reducing recovery time. Platelet-rich plasma (PRP) injections utilize concentrated platelets from the patient’s own blood to promote tissue repair and decrease inflammation within the biceps tendon. Stem cell therapy, using mesenchymal stem cells, offers another regenerative approach by encouraging the growth of healthy tendon tissue. For cases that do not respond to conservative measures, arthroscopic surgery provides a minimally invasive option to repair or remove damaged portions of the biceps tendon, often resulting in quicker recovery and less postoperative pain. The use of advanced imaging modalities, such as MRI and ultrasound, allows for precise diagnosis, targeted injections, and improved surgical accuracy. Collaboration between orthopedic surgeons, physical therapists, and other specialists ensures a comprehensive, multidisciplinary approach to the treatment and rehabilitation of biceps tendon injuries, maximizing the chances of a successful outcome.

Recovery and Prevention

Most people recover well with a combination of rest, physical therapy, and gradual return to activity. Recovery time varies: mild cases may heal in 2-6 weeks, while more severe injuries can take several months. Prevent recurrence by warming up properly, maintaining flexibility, and addressing muscle imbalances, especially in the shoulder girdle. Strengthening and balancing the shoulder girdle can reduce the risk of biceps injuries. Avoid repetitive use of the same shoulder motions, as repetitive shoulder motions—particularly overhead activities—increase the risk of biceps injuries. Use proper lifting techniques.4

Case Studies

Case Study 1: Biceps Tendinopathy in a Tennis Player

Background: A 28-year-old tennis player developed shoulder pain after increasing training intensity.
Treatment: Rest, physical therapy, and prolotherapy.
Outcome: Full recovery and return to competition within 6 weeks.

Case Study 2: Chronic Biceps Tendinopathy in a Manual Worker

Background: A 45-year-old manual worker with 8 months of persistent shoulder pain.
Treatment: Prolotherapy and targeted rehabilitation.
Outcome: 80% pain reduction and return to work within 2 months.

Case Study 3: Recurrent Tendinopathy in a Swimmer

Background: A 35-year-old swimmer with repeated biceps tendinopathy.
Treatment: Strengthening, flexibility program, and prolotherapy.
Outcome: No further recurrences and improved performance.

Frequently Asked Questions

What causes biceps tendinopathy?

Common causes include overuse, repetitive overhead activity, poor biomechanics, muscle imbalances, and age-related degeneration.2 The long head of the biceps tendon originates from the labrum and runs through a groove in the upper arm bone (humerus), which can be a source of pain.

How is biceps tendinopathy diagnosed?

Diagnosis is based on physical exam, history, and sometimes imaging (ultrasound or MRI) to assess the injury.3

Can biceps tendinopathy or biceps tendon rupture heal without surgery?

Yes, most cases heal with rest, physical therapy, and regenerative treatments like prolotherapy. Surgery is rarely needed.

Is prolotherapy safe and effective for biceps tendinopathy?

Yes, prolotherapy is considered safe when performed by experienced practitioners and has shown positive outcomes for tendon injuries in clinical studies.5

How long does recovery take?

Mild cases may heal in 2-6 weeks, while severe injuries can take several months. Adhering to a rehab plan is key.

When should I see a specialist?

If you have severe pain, weakness, swelling, or difficulty moving your arm, see a specialist for diagnosis and treatment.

Contact ProHealth Clinic Today for Your FREE 15-Minute Discovery Call

Don’t let biceps tendinopathy control your life any longer. Join the thousands of patients who have found lasting relief through prolotherapy at ProHealth Clinic.

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Author Bio

Having performed over 10,000 procedures, Mr Oliver Eaton is one of the UK’s leading practitioners in the field of treating biceps tendinopathy, with patients travelling to see him from across the UK, Europe, and the Middle East.

With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with biceps tendinopathy and providing effective treatment options to alleviate them.

He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.

Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.

Mr Eaton’s expertise has been featured in many national news and media publications, including The Telegraph, The Daily Mail, The Daily Express, Women’s Health Magazine, and The Scotsman.

Connect with Oliver Eaton on LinkedIn

References

Ahrens PM, Boileau P. The long head of biceps and associated tendinopathy. J Bone Joint Surg Br. 2007;89(8):1001-1009. View Study
Elser F, Braun S, Dewing CB, Giphart JE, Millett PJ. Anatomy, function, injuries, and treatment of the long head of the biceps brachii tendon. Arthroscopy. 2011;27(4):581-592. View Study
Chew FS, Giuffrè BM. Imaging of the biceps brachii tendon. AJR Am J Roentgenol. 2005;184(2):507-517. View Study
Cain PR, Mutschler TA, Fu FH, Lee SK. Anterior shoulder pain and the biceps tendon. Clin Sports Med. 1989;8(4):741-749. View Study
Rabago D, Slattengren A, Zgierska A. Prolotherapy in Primary Care Practice. Prim Care. 2010;37(1):65-80. View Study

Disclaimer: This article is for informational purposes only and does not substitute for professional medical advice. Always consult your healthcare provider before making treatment decisions.