Biceps tendonitis involves inflammation or irritation of the long head of the biceps tendon, which connects the biceps muscle to the shoulder joint. This condition is a common source of anterior shoulder pain because the tendon is frequently exposed to mechanical stress as it passes through a bony channel called the bicipital groove on the upper arm bone. Irritation often arises from repetitive overhead motion or chronic overuse, leading to micro-tears and subsequent inflammation. Diagnosing this injury requires a combination of patient-reported symptoms, specific physical examination maneuvers, and medical imaging to confirm the findings.
Recognizing the Symptoms of Bicep Tendonitis
Individuals typically describe a deep, aching pain localized in the front of the shoulder that can sometimes radiate downward along the path of the biceps muscle toward the elbow. This discomfort is characteristically worsened by movements requiring lifting, pulling, or reaching overhead. Activities like throwing a ball or lifting heavy objects can significantly aggravate the symptoms. Patients may also notice a painful clicking, snapping, or catching sensation within the shoulder joint, which can suggest instability. Palpating the bicipital groove often reveals distinct tenderness, which is a highly suggestive finding.
Clinical Maneuvers for Diagnosis
A clinician uses several specific physical examination techniques to apply stress directly to the biceps tendon. These maneuvers are designed to provoke the patient’s symptoms, thereby confirming the likely involvement of the long head of the biceps tendon. Two common and effective tests are Speed’s Test and Yergason’s Test, both of which load the tendon against resistance.
Speed’s Test
Speed’s Test assesses the tendon by requiring the patient to resist downward force while the arm is in a specific position. The patient sits or stands with the elbow fully extended and the forearm supinated, meaning the palm faces upward. The arm is then elevated forward to approximately 90 degrees of shoulder flexion. The examiner applies steady downward pressure to the forearm. The test is considered positive if the patient experiences pain localized to the bicipital groove as they attempt to hold the position.
Yergason’s Test
Yergason’s Test specifically evaluates the ability of the biceps tendon to remain stable within its groove and tests for general tendon integrity. The patient’s elbow is bent to 90 degrees, and the forearm is positioned with the palm facing down. The patient is instructed to forcibly rotate the forearm and shoulder outward against the resistance applied by the examiner. A positive result is indicated by localized pain in the bicipital groove or a palpable snapping sensation, suggesting the tendon is unstable or inflamed as it rotates.
Confirmatory Medical Imaging
While clinical maneuvers provide strong evidence, medical imaging is often necessary to confirm the diagnosis, assess severity, and rule out concurrent injuries. Conventional X-rays are typically ordered first to exclude bony issues, such as arthritis or bone spurs, that could be contributing to the shoulder pain. The biceps tendon is soft tissue and not visible on plain radiographs.
Diagnostic Ultrasound
Diagnostic ultrasound is a non-invasive imaging method often used because it allows for a dynamic assessment of the tendon. The clinician can examine the long head of the biceps tendon in real-time as the patient moves their arm. They look for signs such as tendon thickening, fluid surrounding the tendon sheath, or displacement from the bicipital groove. Ultrasound offers a cost-effective and immediate way to visualize the superficial portion of the tendon.
Magnetic Resonance Imaging (MRI)
MRI is considered the gold standard for providing a detailed view of all soft tissues within the shoulder joint. This technology is particularly valuable when the clinical diagnosis is unclear or if a full or partial tear of the tendon is suspected. MRI can visualize the proximal portion of the biceps tendon, which is often obscured by the bony acromion on an ultrasound. It can also simultaneously detect associated injuries like rotator cuff tears or superior labrum anterior to posterior (SLAP) lesions.