Biceps tendonitis (or tendinopathy) is the irritation and inflammation of the long head of the biceps tendon, located where it connects the biceps muscle to the shoulder socket. This condition typically causes a deep, aching pain at the front of the shoulder, often worsened by lifting or reaching overhead. The tendon is susceptible to strain from repetitive motions or age-related degeneration. Addressing this condition requires managing acute symptoms, followed by structured rehabilitation and preventative measures.
Identifying Bicep Tendonitis
The primary signal of biceps tendonitis is a persistent ache in the anterior shoulder region that may radiate down the upper arm. Discomfort intensifies during movements like pulling, lifting, or reaching above the head. Localized tenderness may be felt directly over the bicipital groove, where the tendon passes through the upper arm bone.
The condition often arises from repeated overhead movements, making athletes in sports like baseball, swimming, and tennis susceptible. Poor biomechanics, incorrect lifting techniques, or a sudden increase in training intensity can overload the tendon. This injury is frequently associated with other shoulder issues, such as rotator cuff tears or joint instability.
Immediate Acute Care
The initial response focuses on reducing pain and inflammation to allow the tendon to heal. Immediate rest and strict activity modification are necessary, meaning you must avoid movements that reproduce the pain, especially heavy lifting or reaching above shoulder height.
Applying a cold pack to the painful area for 10 to 20 minutes, several times a day, helps limit local swelling. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can also be taken to manage pain and reduce inflammation during the first few weeks.
If swelling is noticeable, applying a compression wrap and elevating the arm above heart level can encourage fluid drainage. Avoid prolonged immobilization, as this can lead to shoulder stiffness and complicate rehabilitation. If symptoms do not improve significantly after a few days of self-care, seek professional medical assessment.
Professional Treatment and Structured Rehabilitation
When acute measures are insufficient, a healthcare provider will recommend a structured recovery path that addresses the underlying tendon pathology. Physical therapy (PT) is the primary non-surgical intervention designed to restore full shoulder mobility and strength. A physical therapist will first focus on gentle range-of-motion exercises, such as pendulum stretches, before progressing to strengthening protocols.
The strengthening phase focuses not only on the biceps but also on rebalancing the entire shoulder complex. Specific exercises target the rotator cuff muscles and scapular stabilizers, which help to support the shoulder joint and reduce undue stress on the biceps tendon. This controlled loading of the tendon helps promote tissue repair and improves the tendon’s tolerance to strain over time.
If non-operative treatment fails to provide relief after about three months, or if the pain is severe, the doctor may discuss medical interventions. Corticosteroid injections can be delivered into the tendon sheath to reduce inflammation and provide temporary pain relief, although they do not address the long-term structural issue. Care must be taken to avoid injecting the tendon itself, as this carries a risk of tendon rupture.
Surgical Options
In chronic cases where the tendon is severely damaged or degenerated, or if there is a complete tear, surgical options become necessary. The most common surgical procedure is a biceps tenodesis, where the damaged portion of the tendon is removed and the remaining healthy tendon is reattached to the upper arm bone. Another option is a biceps tenotomy, which involves simply cutting the tendon to release the tension, often resulting in a quicker recovery but with the possible cosmetic side effect of a “Popeye” muscle bulge in the arm.
Strategies for Preventing Reinjury
Sustained recovery from biceps tendonitis depends heavily on long-term adjustments to activity and form. Once the pain is resolved and strength is restored, maintaining proper posture and correcting poor technique during sports or lifting is essential to prevent recurrence. This may involve consulting a coach or trainer to refine movements that place excessive strain on the shoulder, such as overhead pressing or throwing.
A consistent routine of warm-up and cool-down is necessary before and after any physical activity involving the upper body. The warm-up should include dynamic movements to prepare the muscles, while the cool-down should incorporate gentle stretching to maintain flexibility. Any increase in physical load, such as adding weight or repetitions to a strength training routine, should be done gradually.
Avoid rapidly increasing activity levels, as this sudden overload is a frequent cause of tendon irritation. Incorporating cross-training and strengthening the entire upper back and shoulder girdle helps to distribute the workload and prevent overuse of the biceps tendon complex. Resting immediately when pain signals return is the most effective way to manage tendon health proactively.