Biceps tendonitis involves irritation and inflammation of the long head of the biceps tendon, typically occurring near the shoulder joint. This cord-like structure connects the biceps muscle to the shoulder socket, and its inflammation often causes a deep, throbbing ache in the front of the shoulder. The condition develops from repetitive overhead motions or general wear and tear, leading to a breakdown of the tendon structure. Pain and tenderness in this area can significantly limit the ability to perform routine activities.
Immediate Relief and Activity Modification
The first step in managing an acute flare-up of biceps tendonitis involves immediate modification of activities to reduce strain on the irritated tendon. Resting the affected arm means completely avoiding movements that trigger pain, especially heavy lifting, overhead work, and forceful flexing of the elbow. Continuing to use the arm in an aggravating way can worsen the condition, potentially leading to fraying or even a tear in the tendon.
Applying cold therapy, such as an ice pack, can help manage the initial swelling and tenderness associated with the condition. Ice should be applied to the front of the shoulder for 15 to 20 minutes several times a day, always using a thin towel to protect the skin. This cooling process helps to numb the local area, offering quick pain relief in the acute phase.
Over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen or naproxen, can also be used to temporarily manage pain and reduce localized swelling. While these medications provide symptomatic relief, focusing on rest and avoiding painful movements for a few weeks is generally the most effective way to calm the initial irritation and prevent further injury.
Professional Medical Intervention Options
If shoulder pain persists beyond a few weeks of diligent self-care, or if sharp pain or a sudden inability to use the arm occurs, seeking professional medical evaluation becomes necessary. A healthcare provider will perform a physical exam and may order imaging, such as an ultrasound or MRI, which can visualize the tendon and help identify any associated issues, like rotator cuff tears.
Formal Physical Therapy (PT) is a primary treatment path, often incorporating hands-on techniques to address the surrounding tissues. A therapist may use manual therapy, including soft tissue massage and joint mobilization, to improve shoulder mechanics and circulation. Other modalities like dry needling, which targets trigger points to stimulate blood flow, or Instrument-Assisted Soft Tissue Mobilization (IASTM) may also be used to break up stiffness and promote healing.
For more immediate pain relief, targeted medical interventions are available. Corticosteroid injections can be administered into the tendon sheath to reduce inflammation, offering short-term symptomatic relief, though they are generally limited due to potential tendon weakening with repeated use. A promising alternative is Platelet-Rich Plasma (PRP) therapy, where concentrated growth factors from the patient’s own blood are injected into the damaged tendon. PRP has shown potential for long-term improvement in pain and function, especially in cases that do not respond to conservative treatment.
Surgical intervention is considered a last resort for chronic, severe cases where conservative treatments have failed over six months or when a significant tear has occurred. The most common procedures are biceps tenodesis, where the tendon is detached and reattached further down the humerus bone, or tenotomy, which involves releasing the tendon completely. Both procedures aim to eliminate the source of pain by preventing the tendon from rubbing in the shoulder joint groove.
Long-Term Recovery and Preventing Recurrence
The transition from acute pain management to long-term recovery focuses on strengthening the tendon structure itself to prevent the condition from returning. This phase centers on therapeutic exercises, with a particular emphasis on eccentric loading, which is a highly effective method for tendon rehabilitation. Eccentric exercise involves lengthening the biceps muscle while it is under tension, which is the controlled lowering phase of a lift.
This controlled lengthening stimulates the production of collagen, helping to remodel and strengthen the damaged tendon fibers in a healthy, aligned pattern. A simple example is the Eccentric Biceps Curl, where a light weight is curled up with assistance from the non-injured arm, but then lowered very slowly, typically over a three to five-second count, using only the injured arm. It is important to begin with minimal weight and gradually increase resistance only when the movement can be performed with proper form.
During this strengthening phase, some mild discomfort during the exercise itself is generally acceptable, but any pain that persists after the exercise session is a sign of overloading the tendon. Incorporating exercises that stabilize the shoulder blade and strengthen the rotator cuff muscles is also a necessary part of prevention. Stronger surrounding muscles reduce the strain placed on the biceps tendon during daily and athletic movements. Re-evaluating form and technique in activities like lifting weights or playing sports ensures the lasting health of the tendon.