The biceps muscle has two tendons at the shoulder. The long head inserts at the top of the socket and the short head inserts adjacent to the socket on the coracoid process of the scapula. Tendonitis occurs most commonly in the long head of the biceps tendon. A debate persists regarding the role of the long head of the biceps in the function of the shoulder. Inflammation is caused by micro tears in the tendon generated by overuse or exceeding the strength of the tendon. Repetitive motion such as throwing, serving, or swinging a golf club can predispose to these micro tears and inflammation.
The tendon of the long head of the biceps travels through a groove on the anterior aspect of the shoulder. If the tendon sustains forces that exceed its strength it sustains micro injuries that lead to inflammation, which enlarges the tendon. Since it is in a small space, it can then be further inflamed by rubbing against the borders of the bicipital groove, which makes it bigger and more inflamed setting up a vicious cycle.
- Repetitive overhead activity either in sport, work, or daily life
- Tendon becomes stiffer as we age and more prone to injury
- Arthritis, which causes bone spurs that can encroach upon the biceps tendon
When the long head of the biceps gets inflamed it functions as a pain generator in the anterior aspect of the shoulder. Biceps tendonitis is characterized by:
- Aching and tenderness on the anterior aspect of the should
- Pain when raising your arm or turning a screwdriver
- Stiffness in the shoulder
- Weakness with overhead lifting
This pain can come on suddenly with one motion or insidiously over time.
- When the pain interferes with your activities of daily living and has not responded to rest and over-the-counter pain reliever
- When you are unable to continue your recreational or sporting activity secondary to anterior shoulder pain or your shoulder pain interferes with your sleep
- You encounter a sudden sharp pain and have a bulge or Popeye deformity in your mid upper arm
Biceps tendonitis can be treated with rest, physical therapy, injections, or surgery depending on the severity and origin of the tendonitis. Surgery is performed when the tendonitis does not respond to nonoperative interventions and can involve simply cutting the tendon known as a tenotomy or cutting the tendon and inserting it into the upper part of the humerus. This eliminates the pain generating trip through the bicipital groove. Recovery is six to 12 weeks depending on the procedure.
- Stretch before activity
- Take breaks when doing continuous overhead activity
- Strengthen your shoulder muscles especially the rotator cuff
- Maintain your range of motion of your shoulder
- Avoid nicotine