Shoulder

Biceps Tendonitis

What is biceps tendonitis?

Biceps tendonitis is an inflammation or fraying of the biceps tendon. The biceps tendon is one of two tendons that run inside of a joint. The biceps tendon is located in the front of the shoulder.  It has two attachments at the shoulder and one attachment at the elbow. The long head of the biceps tendon is typically involved. It originates on the superior labrum, which provides stability to the attachment of the biceps. It then runs through a small space in the rotator cuff called the rotator interval to exit the shoulder and run along the front of the arm, in the bicipital groove.  The biceps tendon can become inflamed and cause pain in the front of your shoulder. Biceps pain and inflammation can arise at any point along the long head of the tendon.

What causes biceps tendonitis?

Biceps tendonitis can result from wear and tear over time. The same forces that can damage the rotator cuff are also involved in wearing the biceps tendon. Alternatively, the biceps can be injured with a forceful contraction of the muscle, or may generate pain in association with a superior labral tear. Biceps tendonitis can be caused by repetitive overhead use of the shoulder.

How is biceps tendonitis diagnosed?

Patients typically complain of pain in the front of the shoulder which is made worse with overhead activity or lifting heavy objects.  Sometimes the pain will radiated down the arm into the biceps muscle.  There is usually tenderness over the over the bicipital groove, an area in the front of the shoulder.  Biceps tendonitis is typically diagnosed on examination. Your doctor can press along the biceps tendon to determine tenderness, and perform a few tests to determine if your shoulder pain is reproduced when using the biceps tendon. Occasionally, damage to the biceps tendon can be seen on MRI.

How is biceps tendonitis treated?

Treatment of biceps tendonitis initially includes non-steroidal anti-inflammatories such as ibuprofen, rest including restriction of overhead activities and lifting. Physical therapy can also help.  Some patients may choose to have a cortisone injection.  The injection is given into the bicipital groove or the shoulder joint, not directly into the tendon. 

What happens if surgery is necessary?

Occasionally, surgery may be needed for persistent pain, often in conjunction with other problems such as rotator cuff tendonitis. The surgery can be performed arthroscopically, and is called a biceps tenodesis or biceps tenotomy. In a biceps tenodesis, the damaged portion of the tendon is cut, and the cut end is secured to bone or soft tissue with sutures, anchors, or a screw. In a biceps tenotomy, the damaged portion of the biceps tendon is cut and allowed to slip down the arm. This removes the damaged area from painful compression in the shoulder.