Bicep tendonitis, or biceps tendinopathy, is a frequent cause of discomfort that is felt directly in the shoulder. This condition involves the inflammation or irritation of the upper portion of the biceps tendon, which is known as the long head of the biceps tendon (LHBT). The pain is often incorrectly attributed to other joint issues, such as rotator cuff injuries, because of the tendon’s unique path through the shoulder structure. Understanding this anatomical connection is the first step in correctly identifying the source of the pain.
The Specific Anatomical Link
The reason bicep tendonitis causes shoulder pain is purely structural, centering on the path of the long head of the biceps tendon. Unlike the short head, the LHBT originates from the superior glenoid labrum, the rim of the shoulder socket. This attachment point means that the tendon is technically intra-articular, or inside the shoulder joint itself.
From its origin, the long head of the biceps tendon courses over the top of the humeral head before exiting through a bony channel called the bicipital groove. As it passes through this groove, it is stabilized by a complex network of ligaments and tendons, including the transverse humeral ligament. This intricate path makes the tendon highly susceptible to friction, compression, and inflammation from repetitive arm movements.
Inflammation or degeneration of the LHBT is a common cause of pain because it affects a tissue anchored directly within the shoulder joint. The tendon also contributes to the stability of the glenohumeral joint, particularly when the arm is raised and rotated. When the tendon is irritated, the resulting pain is perceived as originating from the shoulder joint itself, making it difficult to distinguish from pain caused by rotator cuff issues or labral tears.
Recognizing Bicep Tendon Pain
Bicep tendon-related pain is typically localized to the front of the shoulder, often presenting as a deep, aching sensation. This discomfort is frequently exacerbated by specific movements, which helps differentiate it from other causes of shoulder pain. Patients often feel an increase in pain when lifting the arm overhead, reaching out, or performing actions that require repetitive forearm rotation, such as using a screwdriver.
The pain may also radiate down the arm, following the path of the biceps muscle toward the elbow. Sometimes, individuals report a clicking, snapping, or catching sensation in the front of the shoulder, which can indicate instability of the tendon as it moves within the bicipital groove. Tenderness is often present when pressing directly on the bicipital groove, located on the upper front portion of the arm bone.
A healthcare provider may perform specific physical examination maneuvers to confirm the suspected diagnosis.
Diagnostic Tests
The Speed’s Test involves raising the arm forward against resistance while the elbow is straight and the palm is facing up, which typically intensifies the pain over the tendon.
The Yergason’s Test checks for pain when resisting an attempt to turn the forearm outwards, a movement that stresses the bicep tendon within its groove.
These tests focus on isolating the discomfort to the biceps tendon, providing a strong indication of the source of the shoulder pain.
Initial Management and Medical Confirmation
For new or minor instances of bicep tendonitis, initial home management focuses on reducing inflammation and preventing further irritation. Rest is paramount, meaning the avoidance of activities that aggravate the front of the shoulder, especially heavy lifting or repetitive overhead motions. Applying ice to the painful area for short periods several times a day can help minimize swelling and discomfort. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) may also be used temporarily to manage pain and reduce inflammation.
Activity modification is a simple but effective strategy, requiring the individual to adjust their technique during exercise or daily tasks to relieve strain on the irritated tendon. If the pain persists for more than a week, worsens significantly, or is accompanied by noticeable weakness, consulting a medical professional is necessary. A doctor will begin with a physical examination, utilizing the specific tests that stress the biceps tendon to confirm the clinical diagnosis.
Imaging and Non-Surgical Treatment
To rule out associated injuries, imaging studies may be ordered. X-rays can help eliminate bony issues like arthritis. An ultrasound or magnetic resonance imaging (MRI) scan provides a detailed view of the soft tissues, allowing the doctor to see if the tendon is thickened, frayed, or if there are concurrent rotator cuff tears or labral damage.
Non-surgical treatments are the first line of medical intervention, primarily involving a structured physical therapy program to strengthen the surrounding shoulder muscles and improve joint mechanics. Corticosteroid injections can be delivered around the tendon sheath to provide targeted relief from inflammation, but these are generally used sparingly.
Surgical Options
For chronic cases that do not respond to months of conservative treatment, surgical options may be discussed. The most common procedures are tenodesis, where the damaged tendon is cut from the shoulder joint and reattached to the upper arm bone to remove the source of pain, or tenotomy, where the tendon is simply released. These surgical interventions are typically reserved for severe or chronic pain to restore long-term function.