Tendonitis of the biceps isn’t just about pain, although there is plenty of that: pain that interferes with your activities of daily living, pain that interferes with your sleep, chronic sharp pain with persistent inflammation that can lead to a long list of complications and long-term consequences from progressive shoulder/arm weakness to possible permanent loss of strength/flexibility. Left untreated, tendonitis of the biceps can lead to structural damage, potential tendon tears, and an increased risk of permanent tissue damage. Early medical intervention is crucial to prevent these serious complications and the best place to start is by seeing an orthopedic specialist at the forefront of their field at OCC – Advanced Orthopedic and Sports Medicine Specialists in Denver, Parker, and Aurora, Colorado.

OVERVIEW

Tendonitis of the biceps, also known as biceps tendonitis is also the same as tendinitis. Tendinitis is considered the more accurate medical spelling. They both refer to irritation and inflammation in the long head of the biceps tendon. This tendon connects the bicep to the shoulder, causing pain and tenderness in the front of the shoulder, particularly when performing overhead movements or reaching backward, often caused by repetitive motions or overuse in sports or work activities. This pain can come on suddenly with one motion or insidiously over time. It can also be felt when turning the wrist from a palm facing up to a palm facing down or vice versa. Biceps tendonitis most often occurs in active older adults, primarily between 35-55. Predisposing factors include overuse, improper training, age-related degeneration, and underlying shoulder/arm structural issues. High-risk populations include weightlifters, swimmers, baseball/tennis players, and gymnasts. It affects professionals and weekend warriors. It affects manual labor workers, construction workers, painters, mechanics, and those with jobs requiring repetitive arm movements.

ABOUT THE BICEPS MUSCLE

The biceps muscle is comprised of two heads. At each end are connective tissues called tendons that anchor the muscles to bone. The long head originates from a cavity in the scapula (shoulder blade) called the glenoid. It passes through the shoulder joint to the upper arm through a groove in the humerus (the large bone of the upper arm). The short head originates from a projection on the scapula called the coracoid and runs alongside the long head on the inside of the arm. One of its primary functions is: elbow flexion- when the forearm moves toward the body by bending at the elbow, it’s called elbow flexion. The opposite movement is called elbow extension. The three bones involved in elbow flexion are the: humerus, ulna, and radius. Another primary function is forearm supination- the rotational movement of the forearm that turns the palm upward. It’s the opposite of pronation, which is the downward rotation of the forearm. It is a key muscle in upper limb strength and mobility, helps lift objects toward the shoulder, is the primary mover in curling motions, and is critical for hand movements.

WHAT IS THE TENDONITIS OF THE BICEPS?

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. Biceps tendonitis is a condition that occurs with inflammation in the upper biceps tendon. This tendon — also known as the long head of the biceps tendon — connects the biceps muscle to the shoulder blade bone. The condition can also occur at the elbow. Biceps tendinitis doesn’t typically occur alone. It most often happens alongside other shoulder issues, including:

• Shoulder arthritis
• Dislocated shoulder
• Shoulder impingement syndrome

There are two main types:

At the shoulder: Affects either the long-head tendon (which connects to the top of the shoulder socket) or the short-head tendon (which connects to the coracoid process, a hook-shaped bony projection on the shoulder blade (scapula) that serves as an attachment point for several muscles and ligaments, essentially acting as a critical anchor for stabilizing the shoulder joint)

At the elbow: Affects the distal biceps tendon that connects to the radius bone in the forearm

CAUSES

• Overuse injury that often happens due to a repeated overhead motion
• Heavy lifting
• Poor posture
• Sudden injury
• Age-related wear and tear
• Participating in sports and other physical activities that increase the risk of biceps tendonitis include: swimming, tennis, baseball, or softball. Swinging a golf club can predispose one to these micro tears and inflammation.
• Arthritis, which causes bone spurs can encroach upon the biceps tendon
• Smoking

SYMPTOMS

• Pain or tenderness in the front of the shoulder 
• Pain worsening with overhead activities 
• Clicking or snapping sensation in the shoulder 
• Stiffness in the shoulder
• Pain when reaching backward 
• Possible weakness in the shoulder 
• Upper arm muscle pain that moves down the upper arm bone

NON-SURGICAL TREATMENTS

1. Over-the-counter NSAIDs like ibuprofen or naproxen can help manage pain and inflammation
2. Corticosteroid injections (though these should be used sparingly as they can weaken the tendon if overused)
3. Ice and Heat Therapy: Apply ice for 15-20 minutes several times a day, especially after activity, to reduce inflammation. Once acute inflammation subsides (usually after 48-72 hours), heat therapy can help increase blood flow and promote healing.
4. In severe cases, corticosteroid injections may be considered
5. Activity modification to avoid aggravating movements 
6. Physical therapy exercises to strengthen the shoulder muscles and improve range of motion 

WHEN IS SURGERY INDICATED?

If more conservative treatments aren’t working well enough, surgery may be recommended. Surgery may be the best option for a related shoulder condition that requires repair. Procedures may include biceps tenodesis where the surgeon removes the damaged section of the biceps, and the remaining tendon is reattached to the upper arm bone (humerus). With tenotomy, in severe cases, the surgeon releases the damaged biceps tendon from its attachment. Other potential reasons for surgery for tendonitis of the biceps include pain persisting 6-12 months, complete tendon rupture, chronic instability, recurring functional limitations, performance impact, or severe structural damage. Debridement is an option.” Debridement” in the context of biceps tendonitis refers to a surgical procedure where a doctor removes only the damaged, frayed, or torn parts of the biceps tendon, leaving the healthy portion intact, essentially cleaning up the injured area to promote healing and alleviate pain. This is often done arthroscopically using a small camera and surgical tools inserted into the shoulder joint.

GETTING THE RIGHT DIAGNOSIS.  GETTING THE RIGHT DOCTOR.

Getting an expert diagnosis is the first step in treating tendonitis of the biceps. This is why consulting with a renowned surgeon at Advanced Orthopedics in Denver, Parker, or Aurora, Colorado, is the very first step you should take if you have biceps concerns. Proper diagnosis is crucial because biceps tendonitis symptoms can mimic other conditions like rotator cuff injuries, bursitis, or cervical radiculopathy. An experienced doctor can perform specific physical examinations and order appropriate imaging to differentiate between these conditions and ensure the correct diagnosis. Second, biceps tendonitis treatment needs to be carefully tailored to the specific location, severity, and underlying cause. For instance, proximal biceps tendonitis (near the shoulder) may require different treatment approaches than distal tendonitis (near the elbow). A skilled doctor can determine whether the condition is acute or chronic, assess contributing factors like overuse or improper technique, and develop an appropriate treatment plan. Third, inadequate or improper treatment can lead to:

• Chronic pain and dysfunction
• Progression to more severe tendon degeneration
• Development of compensatory movements that could cause additional injuries
• In severe cases, potential tendon rupture

Finally, highly skilled and experienced doctors like those at Advanced Orthopedics are well-known for their rate of successful outcomes. They care deeply about their patients, helping to guide them through the process and provide strategies to prevent recurrence. If you are suffering from biceps tendonitis, schedule an appointment today with an arm specialist at Advanced Ortho.