Biceps Tendonitis is a common source of shoulder pain for athletes who participate in repeated overhead activities such as tennis, basketball, and weight lifting and for other active people as they get older and the shoulder begins to degenerate or wear out. Overhead injuries (shoulder) are relatively common in these athletes. The biceps muscle is located in the front of your upper arm. It is the muscle that extends from the front of the shoulder area to the elbow, and it is responsible for helping one bend the elbow and rotate the forearm.  There are two tendons at the upper end of this muscle.  One tendon attaches inside the shoulder joint and is referred to as the “long head”.  This tendon is injured more commonly. The “short head” of the biceps attaches closer to the midline on the coracoid process of shoulder blade. Injuries to this tendon are rare.

When the long head of the biceps tendon becomes inflamed and irritated, shoulder pain and weakness can be the result. This pain in the front of the shoulder and occasionally mechanical symptoms such as catching or locking are the common symptoms of a condition we call biceps tendonitis.

Biceps tendonitis can occur from an overuse injury of the shoulder where the same rotating or lifting motion is performed repeatedly. An example of this can be found in competitive swimmers where athletes perform the same motion with their shoulders over and over again. Basketball players also can suffer from overhead injuries.  Shoulder pain and persistent weakness are the primary result. The long head biceps tendon can also be injured alongside other shoulder problems such as rotator cuff tears, arthritis of the shoulder joint, shoulder impingement, or shoulder instability.  All of these shoulder conditions can cause situations where the long head biceps tendon can become damaged, inflamed, unstable, partially torn, or even completely torn.

Symptoms of Biceps Tendonitis

Biceps tendonitis will result in a constant or intermittent shoulder pain or ache in the front of shoulder area. Frequently this pain will radiate down the front of the arm into the biceps muscle. The symptoms associated with biceps tendonitis usually get worse with overhead lifting and reaching. Many patients will hear an occasional popping sound or snapping sensation in the shoulder area as well.  This occurs when the biceps tendon becomes unstable and pops in and out to the bicipital groove, a small indention or groove on the upper part of the humerus where the tendon resides. Biceps tendonitis can usually be treated with rest and activity modification. If the condition worsens and treatment is not sought, the long head biceps tendon may remain persistently painful, unstable, or in some cases it may tear. When the biceps tendon fails to slide in the bicipital groove a labial or slap tear may occur.  With this condition, surgery is sometimes needed.

Treatment for Biceps Tendonitis

When chronic symptoms develop or when there is an acute rupture of the long head biceps tendon, medical attention should be sought.

Nonsurgical Treatment

Depending on the severity of the symptoms and results shown by physical examination and imaging tests such as an MRI, Dr. Millett will initiate a treatment plan. In most instances, doctors try to treat biceps tendonitis non-surgically. Even complete ruptures can sometimes do well without surgical treatment. The first step is to rest the shoulder and eliminate all overhead activity.  A sling may be required to keep the arm stable and in a resting state.  Applying ice, several times a day for about 20 minutes per session, helps reduce swelling and pain; non-steroidal, anti-inflammatory medicines (such as ibuprofen) can also be helpful. After a period of rest, physical therapy may be prescribed with strengthening movements and stretching exercises so that range of motion can be restored.

Surgical Treatment

In many cases surgery is needed to alleviate the chronic pain of biceps tendonitis.  Oftentimes, the surgery to treat the biceps will accompany another treatment procedure that is taking place to treat another shoulder problem, most commonly rotator cuff problems.  Surgical intervention for the treatment of biceps tendonitis is usually done arthroscopically. During arthroscopic shoulder surgery, Dr. Millett will make small incisions around the shoulder and insert a camera and tiny instruments through the incisions to assess the biceps tendon and repair it.  If during the surgery Dr. Millett determines that the damaged section of the biceps tendon is too inflamed, he may remove this area and reattached the remaining healthy tendon to the humerus (upper arm bone).  This procedure, known as a biceps tenodesis, is extremely successful in removing the painful symptoms and restores function for the patient. Dr. millett has performed over 1000 of these procedures and has had a very high success rate and a very, very low (<1%) severe complication rate.

Surgical Treatment of Chronic Long Head Biceps Ruptures

Most ruptures of the long head biceps tendon can be treated without surgery, although some patients will have persistent cramping and pain associated with the rupture. This can also occur after a surgical procedure called a biceps tenotomy. Others will be bothered by the disfigurement, called a popeye deformity. In these cases, there is a surgical option to treat this type of condition. This is called an open biceps tendodesis. Through a small incision the torn and retracted tendon or muscle is retrieved and pulled up and reattached the humerus. This restores the biceps muscle so it can work properly and eliminates the deformity of the ‘poppy’ muscle. Dr. Millett has performed repair of many chronic ruptures, some of which occurred as many as 25 years earlier.

Results and Rehab

Patients who undergo arthroscopic shoulder surgery for the treatment of biceps tendonitis typically have excellent and predictable results. Dr. Millett believes that the treatment of biceps tendon disorders is among the most satisfying of all the surgical treatments because it is so predictable. Most will regain full range of motion in a few short weeks.  Following the rehab protocol and physical therapy regime as set by Dr. Millett will be necessary in order to ensure a successful recovery.

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(Click to Enlarge) The left arthroscopic image shows a normal, healthy proximal biceps tendon. The right arthroscopic image shows tenosynovitis of the proximal biceps tendon that underwent subsequent biceps tenodesis.