Bicep tendonitis, the inflammation of the biceps tendon, is a common cause of pain felt in the shoulder. The anatomical connection between the biceps tendon and the shoulder joint means that irritation often manifests as shoulder pain, particularly in the front of the joint. This condition can restrict daily activities and movement. Understanding the symptoms, causes, and available treatments is the first step toward recovery and regaining full shoulder function.
How Bicep Tendonitis Affects the Shoulder Joint
The biceps muscle has two heads, but the long head of the biceps (LHB) tendon is the structure intimately involved with the shoulder joint. This tendon originates inside the shoulder joint capsule, attaching to the superior labrum, the rim of cartilage surrounding the shoulder socket.
From its attachment point, the LHB tendon takes a curved path across the top of the humeral head (the ball of the joint). It then exits the joint by passing through a bony channel on the upper arm bone called the bicipital groove. This course makes the tendon susceptible to friction and mechanical wear. Inflammation in this segment leads to swelling that can press against the surrounding structures.
The constant movement of the arm causes the inflamed LHB tendon to rub repeatedly within the bicipital groove, producing pain felt deep within the shoulder. The LHB tendon helps stabilize the glenohumeral joint, and when it becomes irritated, this stabilizing function is compromised, contributing to pain and instability. Bicep tendonitis often coexists with other shoulder issues like rotator cuff tears or labral tears. The resulting inflammation in the joint area is interpreted as generalized shoulder pain.
Recognizing the Symptoms and Causes
The pain associated with bicep tendonitis is typically localized to the front of the shoulder. Patients often describe a deep, throbbing ache that can radiate down the arm toward the elbow. This anterior shoulder pain usually worsens when performing overhead activities, such as reaching for a high shelf, or with repeated lifting motions.
Mechanical symptoms are also characteristic of this condition, including a clicking, snapping, or catching sensation in the shoulder joint during movement. Tenderness is present when pressure is applied directly over the bicipital groove, which helps distinguish it from other sources of shoulder pain. The pain may also be more pronounced at night, particularly if sleeping on the affected side.
The causes of bicep tendonitis are related to repetitive strain and overuse, leading to gradual wear and tear on the tendon. Sports that involve frequent overhead movements, like swimming, baseball pitching, or tennis, are common risk factors. The constant friction and stress from these activities can cause the LHB tendon to fray, swell, and become inflamed.
Direct trauma can also initiate the condition, although age-related degeneration is a frequent contributing factor. As people age, the tendon naturally loses strength and elasticity, making it more vulnerable to injury. Chronic instability in the shoulder joint can also place abnormal stress on the LHB tendon, leading to inflammation and pain.
Navigating Treatment and Recovery
Initial treatment for bicep tendonitis focuses on conservative methods aimed at reducing inflammation and pain. Rest and activity modification are primary, meaning activities that aggravate the shoulder, especially overhead movements, should be avoided temporarily. Applying ice to the front of the shoulder can help decrease swelling and tenderness.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended to manage pain and reduce the inflammatory response. If conservative measures are insufficient, a medical professional may recommend a corticosteroid injection into the tendon sheath to provide localized anti-inflammatory relief.
Physical therapy plays a significant part in long-term recovery, focusing on restoring pain-free range of motion and improving shoulder mechanics. The program typically includes stretching exercises to address tightness and targeted strengthening exercises for the rotator cuff and biceps muscles. This helps stabilize the joint and reduce excessive strain on the LHB tendon.
For chronic or severe cases that do not respond to conservative management, surgical options may be discussed. The two primary procedures are biceps tenotomy and biceps tenodesis.
Biceps Tenotomy
A tenotomy involves cutting the LHB tendon to release the source of pain, allowing it to retract down the arm.
Biceps Tenodesis
A tenodesis involves cutting the tendon and then reattaching it to a new location on the humerus bone. This is often preferred for active individuals to maintain biceps muscle contour and function.