Bicep tendonitis is a common source of shoulder pain that involves irritation or inflammation of the long head of the biceps tendon. This condition frequently affects individuals who engage in repetitive overhead motions, such as athletes in throwing sports or laborers whose work requires constant lifting. While the biceps muscle extends from the shoulder to the elbow, the pain associated with this specific tendon issue is most often felt near its upper attachment, or proximally, at the shoulder joint.
Understanding Bicep Tendon Anatomy
The biceps muscle has two heads, the short head and the long head, but bicep tendonitis almost exclusively involves the long head of the biceps tendon. This tendon begins its path deep within the shoulder joint, originating from the supraglenoid tubercle on the shoulder blade. It is an intra-articular structure.
The long head of the biceps tendon then passes through a narrow bony channel on the front of the upper arm bone, the humerus, known as the bicipital groove. This groove acts as a pulley system, guiding the tendon’s path and stabilizing it during arm movement. The tendon’s vulnerable position in this tight, dynamic groove makes it susceptible to friction and compression, leading to the irritation and degenerative changes associated with tendinopathy. The stability of the tendon in this groove relies on surrounding soft tissues, including a sling formed by parts of the rotator cuff tendons and ligaments.
The Primary Location of Proximal Pain
The pain caused by bicep tendonitis is localized to the front aspect of the shoulder. Patients typically report a deep, throbbing ache that sits just beneath the surface of the skin. The most specific location of tenderness is directly over the bicipital groove of the humerus, which can be found by gently pressing on the front of the shoulder near the armpit.
This specific site of localized pain is where the irritated tendon slides back and forth during arm movements. Tenderness upon palpation of this groove is a classic clinical finding for the condition. While the bicep muscle itself extends down the arm, the sensation of tendinopathy is centered at this proximal attachment site. Occasionally, the pain may radiate slightly down the upper arm bone toward the elbow, but the focal point remains the shoulder.
Associated Symptoms and Functional Limitations
Bicep tendonitis presents with dynamic symptoms that restrict daily activities. The pain is often exacerbated by movements that require the biceps muscle to work against resistance or to stabilize the arm. These movements include reaching overhead, lifting objects, or rotating the forearm outwards against a load, such as turning a screwdriver. While the pain may present as a dull ache while at rest, it can spike into a sharp, intense pain during these activities.
The irritation of the tendon can also lead to mechanical symptoms within the shoulder joint. Patients sometimes report an audible or palpable clicking, snapping, or grinding sensation when moving their arm, particularly during rotation. Furthermore, the pain and irritation can cause a secondary weakness, making simple tasks like carrying groceries or throwing a ball difficult. Pain that wakes a person when sleeping on the affected side is also a common complaint with this condition.
When to Seek Professional Guidance
Self-Management and Diagnosis
Many mild cases of bicep tendonitis can improve with self-management, including rest, applying ice, and taking over-the-counter anti-inflammatory medications. If the pain persists for more than a few weeks despite these conservative measures, a healthcare provider should be consulted. A medical professional can perform a physical examination and specialized tests to confirm the diagnosis and rule out other shoulder pathologies.
Signs of a Tendon Tear
You should seek immediate medical attention if you experience a sudden, sharp pain accompanied by a popping sound or sensation in the shoulder or upper arm. These symptoms, especially if followed by significant bruising or the appearance of a noticeable bulge in the upper arm, may indicate a partial or complete tear of the biceps tendon.
Chronic Pain and Imaging
For chronic pain that limits your ability to perform daily tasks, a physician or physical therapist can guide you through non-surgical management, which often includes targeted physical therapy. Diagnostic imaging, such as an ultrasound or MRI, may also be used to visualize the tendon and assess the extent of the damage.