Clinics in Bedford
Open Mon-Fri 9-5pm

Biceps Tendinopathy

Understanding Biceps Tendinopathy: Symptoms, Causes, and Treatments

Our guide delves directly into the root of what prompts biceps tendinopathy, leading to persistent discomfort in the front area of your shoulder and limited arm mobility. It provides a comprehensive look at symptoms, underlying reasons for pain, and therapeutic approaches designed to assist you on the path to recovery.

Key Takeaways

  • Biceps tendinopathy is a condition characterized by pain and inflammation or degeneration of the biceps tendon, often due to overuse, and is commonly diagnosed through a combination of physical examination and imaging techniques.
  • Conservative management of biceps tendinopathy includes activity modification, physiotherapy, and medication, while severe cases unresponsive to these methods may require surgical intervention such as biceps tenotomy or tenodesis.
  • Successful rehabilitation from biceps tendinopathy involves a balanced regimen of rest, recovery exercises, and postoperative care if surgery is performed, with a focus on long-term prevention and management through correct technique and regular stretching.

Understanding Biceps Tendinopathy

Illustration of biceps tendon and surrounding structures

Biceps tendinitis encompasses a range of issues related to discomfort and inflammation surrounding the biceps tendon, specifically affecting the long head that attaches the biceps muscle to your shoulder’s upper region. The spectrum of this disorder spans from an early stage characterized by acute inflammatory responses to a more chronic phase known as degenerative tendinopathy. This evolution reflects a shift from initial inflammation towards prolonged tissue deterioration over time. Contrary to conventional understanding, modern research suggests that changes in the degeneration of the bicep tendon can occur with only negligible levels of inflammation, which may advance toward injuries such as tears or complete ruptures within its enclosing sheath.

The inherent vulnerability of the long head of the biceps tendon is heightened due to its strategic location and relatively insufficient blood supply. These factors are key contributors underlying various forms of bicep tendon pathology. As individuals experience progression in their condition, they often report concentrated pain on anterior parts near their shoulders—an area correlated with where their tender and affected BICEPS TENDON resides. Since instances involving damage or disease linked with this particular part of the muscle structure might be quite common but aren’t precisely quantified in prevalence yet recognizing symptoms along with underlying triggers remains critical for healthcare providers and patients alike.

Symptoms and Presentation

Individuals with biceps tendinopathy may exhibit a variety of symptoms, including:

  • The presence of pain at the front part of the shoulder in the vicinity of the bicipital groove is common. This discomfort can often extend towards the elbow and might be associated with proximal biceps instability pain.
  • Any motion involving raising (flexing) of the shoulder, turning (supinating) one’s forearm, or bending (flexing) at their elbow could exacerbate this type of distress.
  • It is also commonly reported that patients suffer from pain during nighttime hours, suggesting that troubles linked to biceps tendinopathy have potential to remain even while not actively moving.

It’s crucial to recognize these described symptoms are not solely indicative of just biceps tendinopathy but could signal various conditions affecting areas around shoulders. As such, should you notice any aforementioned signs it becomes vital seeking professional medical evaluation through an orthopedic specialist or therapist well versed in physiotherapy. Importantly remember that patient experiences related to pain differ – variations exist concerning how suddenly it begins, its severity level and lasting period.

Causes and Risk Factors

Numerous elements can precipitate the emergence of biceps tendinopathy, and in certain scenarios, these factors may also cause a rupture of the biceps. Commonly identified causes consist of:

  • An abrupt escalation in physical activity levels, especially seen in athletes between 18 to 35 years old
  • Age-related degenerative alterations noted among individuals older than 65
  • Particular athletic activities like baseball, softball, and volleyball that require intensive arm movements

These aspects contribute to the onset of biceps tendinopathy within the muscle known as the biceps brachii.

Physical conditions influencing the well-being of the long head of the biceps (LHB) tendon include:

  • A deficiency in glenohumeral internal rotation impacting upon how rotating motions affect humeral head positioning
  • Inadequate control over trunk stability
  • Dysfunctional movement patterns associated with scapula motion or “scapular dyskinesia”
  • Internal impingement phenomena

Understanding such causal agents and risk elements is instrumental for crafting effective approaches toward both preventing and addressing issues related to bicep tendinopathy.

Diagnosing Biceps Tendinopathy

MRI scan showing biceps tendinopathy

A mix of physical examination and imaging techniques is used to diagnose biceps tendinopathy. The diagnostic criteria for biceps tendinopathy include the presence of at least one of the defined criteria, often determined through a detailed physical examination. Imaging techniques such as radiography, ultrasonography, and MRI are used to confirm a diagnosis of biceps tendinopathy. Biceps tendinopathy is often misdiagnosed and may coexist with shoulder impingement syndrome in many patients.

Accurate diagnosis is crucial, as it not only confirms the presence of biceps tendinopathy, but also helps rule out other potential shoulder pathologies. Keep in mind, only a qualified medical professional can provide a reliable diagnosis, utilizing a thorough examination and appropriate diagnostic tools.

Physical Examination

Conducting a comprehensive physical examination is essential for diagnosing biceps tendinopathy. The exam should consist of the following steps:

  • Feeling along the bicipital groove with slight internal rotation of the arm to detect any soreness, which would suggest biceps tendinopathy.
  • Evaluating movement in the cervical spine, shoulder, and elbow to check for any limitation that might be associated with this condition.
  • Performing strength tests on the shoulder, elbow, and wrist to determine if there is notable weakness indicative of biceps tendinopathy.

It’s worth noting that an intriguing component within such examinations involves utilizing local anesthesia. By administering these injections into areas around the bicipital groove while examining a patient can provide confirmation as to whether pain stems from biceps tendinopathy or not. This technique isn’t typically employed during standard exams but can yield crucial diagnostic information regarding this specific form of tendon injury.

Imaging Techniques

Multiple imaging modalities are crucial in confirming a diagnosis of biceps tendinopathy, beyond just physical examination. Bicipital groove-specific radiographs may reveal calcifications or signs of wear and tear on the biceps tendon, as well as degenerative changes in adjacent joints. Radiographic images can appear normal when there is no co-occurring shoulder condition.

A cost-effective and dynamic option for detailed visualization, ultrasonography can identify abnormalities like sheath swelling or fluid buildup in both the biceps tendon and rotator cuff, assisting with detecting ruptures or instability within these structures. Meanwhile, MRI scans are instrumental in ruling out alternative pathologies that could present symptoms similar to those of biceps tendinopathy. These advanced imaging techniques facilitate thorough investigation into the state of the tendon and its nearby anatomy—information critical for accurately diagnosing issues and deciding whether intervention through shoulder elbow surgery is warranted.

Conservative Treatments for Biceps Tendinopathy

For those suffering from biceps tendinopathy, the first line of defense often includes non-invasive treatments such as modifying one’s activities, undergoing physical therapy, and taking medication to control symptoms and facilitate recovery. There are different forms of tendon pathology related to biceps tendinopathy—including tendinitis, peritendinitis, and tendinosis—each necessitating its own particular approach for effective management.

When it comes to conservative care for biceps tendinopathy, managing pain with NSAIDs is a common practice at the onset. Exercises aimed at stretching and strengthening form an essential part of treating this condition conservatively. These exercises are also pivotal in preventing recurrent episodes. Delving deeper into these non-surgical interventions can provide greater insight into their importance in addressing issues stemming from biceps tendinopathy.

Activity Modification and Rest

Adjusting exercises and activities is essential when managing biceps tendinopathy, which requires:

  • Diminishing the intensity and motion range of specific workouts.
  • Altering gym routines like pressing movements or seeking alternatives that won’t worsen biceps tendinopathy.
  • Limiting actions that initially cause the overuse of the bicep tendon.

Undertaking these steps is crucial for addressing biceps tendinopathy successfully.

Proper handling of daily tasks to incorporate rest intervals helps in managing biceps tendinopathy. Consider adopting strategies such as:

  • Reducing or steering clear from acts that aggravate symptoms associated with this condition, including reaching overhead.
  • Emphasizing adequate rest periods to expedite recovery processes.
  • Using cold therapy on impacted regions may aid in diminishing inflammation alongside discomfort levels.
  • Massaging affected areas can enhance circulation while easing strain within those zones

Engaging in stretching regimens enhances pliability and mitigates rigidity. Employing heat treatments can offer symptom relief too.

Striking an equilibrium between physical engagement and downtime serves as a cornerstone strategy for effective management of biceps tendinopathy.

Physical Therapy

Physical therapy for biceps tendinopathy

The conservative management of biceps tendinopathy places significant emphasis on physical therapy, which encompasses a range of activities such as:

  • Static strength training exercises
  • Strengthening movements that involve both lengthening and shortening muscle actions
  • Progressive tendon load enhancement
  • Customizing the rehabilitation process by adjusting factors like the length of levers in exercises, resistance levels, and the speed at which exercises are performed to suitably modify stress placed on the biceps tendon.

Other elements integral to physical therapy for treating biceps tendinopathy might comprise strategies like RICE (rest, Ice, Compression, Elevation), methods targeting soft tissue treatment and a variety of shoulder-specific workouts. These workouts aim to bolster flexibility and muscular power while also enhancing joint functionality—each being an essential component for recovering from an affliction affecting the biceps tendon.

Medication and Injections

Sometimes, symptoms of biceps tendinopathy may not respond adequately to conservative approaches such as modifying activities and undergoing physical therapy. In these instances, patients might contemplate medications and injections. Among the options is a biceps tendon sheath injection. When initial non-invasive treatments are unable to provide relief for ongoing discomfort related to biceps tendinopathy, corticosteroid injections come into play. Compared with oral NSAIDs, these steroid injections can lead to greater functional gains in managing shoulder pain linked with this condition. There’s no heightened risk of complications from steroid injections for biceps tendinopathy compared to taking oral NSAIDs.

Oral NSAIDs also serve the purpose of alleviating pain and reducing inflammation caused by biceps tendinopathy, but they typically offer less functional benefit than their injectable steroid counterparts when it comes to improvement measures. Fundamentally, resorting to medication along with injection therapies becomes an option worth considering only after traditional conservative methods have fallen short in providing adequate symptom mitigation for individuals suffering from biceps tendinopathy.

Surgical Options for Biceps Tendinopathy

In instances where non-operative measures do not offer sufficient relief, it may be necessary to explore surgical intervention. The decision for surgical management of biceps tendinopathy arises after conservative treatments have proven ineffective and is typically recommended for individuals with a high level of activity or athletes suffering from significant active pathology.

To understand the interventions available in treating biceps tendinopathy, we should delve into two prevalent surgeries: biceps tenotomy and biceps tenodesis. Each procedure plays its own part in addressing discomfort associated with this condition.

Biceps Tenotomy

Surgical procedure for biceps tenotomy

The surgical process known as biceps tenotomy entails cutting the long head of the biceps tendon from its point of connection at the glenoid. During this procedure, there is no reattachment of the severed bicep tendon. Hence it withdraws into retraction.

Following are some advantages patients may experience with a tenotomy:

  • Accelerated healing due to eliminating the need for tendon reconnection
  • Frequently chosen for elderly or less physically active individuals
  • Aesthetic irregularities like a “Popeye” bulge in the arm typically do not pose major issues

Biceps Tenodesis

Biceps tenodesis serves as an alternative surgical procedure aimed at alleviating discomfort and improving shoulder and biceps functionality resulting from a torn upper biceps tendon, specifically the long head, or due to a rotator cuff tear. This method differs from tenotomy as it involves resecuring the detached upper portion of the biceps tendon directly to the humerus—the bone in the upper arm. Surgeons may execute this operation through traditional open surgery or via arthroscopic techniques. With arthroscopy being favored for its minimally invasive nature that also results in less noticeable scarring.

Often selected for individuals who lead active lifestyles or those who are attentive to aesthetic outcomes, tenodesis is beneficial because it helps preserve the natural shape of the biceps muscle. Such considerations make it particularly appealing for younger patients worried about maintaining their muscle’s appearance post-surgery.

Rehabilitation and Recovery

Whether one undergoes a surgical or non-surgical approach to treating biceps tendinopathy, rehabilitation is essential for healing. This restorative program typically spans 2 to 6 weeks and concentrates on preserving the range of motion in the shoulder, applying suitable tendon loads, as well as improving strength and stability in the upper limb. The emphasis throughout this period is placed on active recovery along with a careful resumption of activities that supports effective recuperation.

After initial symptoms have begun to diminish, there should be a carefully managed return to normal functions. It’s important first to focus on regaining movement before progressing intensity levels, volume of exercise, and speed incrementally during this phase. Both post-surgical care, if applicable, and exercises designed for enhancing muscle strength and joint stability, are integral at this stage.

Postoperative Care

Postoperative care following a biceps tenodesis is essential for a smooth recovery. To manage post-surgical pain, ice packs and analgesics are frequently employed. Postoperatively, the use of a sling aids in both supporting the arm and providing comfort as healing begins. For additional insights into postoperative protocols, refer to recent studies found in J Shoulder Elbow Surg.

Gradual resumption of activities is paramount after sufficient healing has taken place to avoid undue strain on repaired tissues. Essentially, the focus of postoperative treatment centers around pain control, safeguarding recovering tissues, and carefully progressing back to routine activities.

Strengthening and Stability Exercises

A thorough exercise program, essential for effective rehabilitation and recovery, focuses on strengthening the biceps tendon as well as stabilizing shoulder girdle and core muscles.

Strengthening the serratus anterior is vital in promoting correct movement of the shoulder blade and maintaining overall shoulder well-being. This is particularly significant for individuals recovering from biceps tendinopathy. These strengthening routines not only contribute to healing, but also play a preventive role against recurrent instances of biceps tendinopathy.

Prevention and Long-term Management

To prevent the recurrence of biceps tendinopathy following recovery, it is essential to focus on long-term management and preventative measures. This includes modifying activities as needed, adhering to proper techniques during physical tasks, and maintaining a consistent exercise regimen. Adopting appropriate posture and ensuring correct movement patterns during various activities can help reduce the likelihood of experiencing biceps tendinopathy again.

It is especially important to steer clear of repetitive motions above the head that could irritate the tendon, which are often associated with this condition. A comprehensive exercise routine that promotes balance will support both shoulder joint stability and biceps tendon integrity, contributing to preventing a relapse into tendinopathy.

Activity Modification and Proper Technique

Preventing biceps tendinopathy necessitates activity modification and the use of correct techniques. Using proper technique when performing activities helps eliminate unnecessary strain on the tendon. To prevent biceps tendinopathy, follow these tips:

  • Ensure elbows are close to the body when lifting
  • Lift with the legs, not the arms
  • Avoid lifting heavy weights that are beyond your capacity
  • Take breaks and rest when needed
  • Warm up before exercising to prepare the muscles and tendons
  • Stretch and cool down after exercising to promote flexibility and recovery

By following these guidelines, you can reduce the risk of biceps tendinopathy and maintain healthy and strong tendons.

Reducing repetitive activities, especially those involving overhead movement, can result in overuse injuries to the biceps tendon, necessitating activity modification to prevent tendinopathy.

Regular Exercise and Stretching

To prevent biceps tendinopathy, consistent exercise and stretching routines are essential. Programs like the ‘Thrower’s 10 Program’ not only fortify the biceps tendon but also enhance the strength of surrounding muscles, thus mitigating tension on the tendon itself.

During recovery from tendinopathy, several exercises that aid in maintaining both flexibility and robustness of the shoulder and biceps should be performed regularly.

  • Elevating arms straight overhead for shoulder flexion
  • Performing curls specifically targeting bicep muscles
  • Stretching to elongate bicep muscle fibers
  • Executing stretches encouraging internal rotation at shoulders
  • Engaging in stretches facilitating external rotation at shoulders
  • Rotational movements focused on strengthening forearm muscles

The aim of these activities is to preserve a full range of motion as well as to deter stiffness within the biceps which could intensify symptoms related to tendinopathy.


Biceps tendinopathy is a common but often misunderstood condition that can significantly impact an individual’s daily activities and quality of life. From understanding its symptoms and causes to exploring both conservative and surgical treatment options, we hope this blog post has provided valuable insights into this condition. Remember, early diagnosis and treatment are key to a swift recovery. Therefore, if you or someone you know is experiencing symptoms of biceps tendinopathy, it’s essential to seek professional medical advice promptly.

Frequently Asked Questions

What is biceps tendinopathy?

Pain and inflammation characterize biceps tendinopathy, a condition affecting the tendon of the long head of the biceps muscle where it attaches to the shoulder socket.

How is biceps tendinopathy diagnosed?

A diagnosis of biceps tendinopathy is established by employing a mix of physical examination and diagnostic imaging methods, which include radiography, ultrasonography, and MRI. These approaches are instrumental in recognizing the illness and ascertaining the optimal treatment strategy.

What are the conservative treatments for biceps tendinopathy?

For conservative management of biceps tendinopathy, options such as altering your activities, engaging in physical therapy, and using medication can prove to be effective. These strategies are designed not only to relieve pain but also to deter any additional exacerbation of the ailment.

What surgical options are available for biceps tendinopathy?

Treating biceps tendinopathy typically involves two primary surgical procedures: biceps tenotomy and biceps tenodesis, each designed to effectively manage the condition.

How can I prevent biceps tendinopathy?

In order to reduce the likelihood of developing biceps tendinopathy, it is essential to adjust activities as needed, ensure correct technique is employed, and sustain a well-rounded exercise regimen that incorporates both stretching and muscle strengthening routines.

Adhering to these measures can play a crucial role in mitigating the chances of encountering this condition.

Read more: