Biceps Tendinitis: Overview

Biceps Tendinitis: Overview

Biceps tendinitis is irritation or inflammation at the top portion of the biceps tendon. This inflammation leads to pain in the front of the shoulder. Biceps tendinitis commonly occurs over time with general wear and tear to the shoulder, although it can also come on suddenly due to an acute injury.

Inflammation can range from mild to more severe, resulting in changes to the shape of the tendon or different degrees of tearing, including a complete rupture of the tendon from its attachment site. Biceps tendinitis often occurs in conjunction with other conditions of the shoulder joint, a rotator cuff tear being most common. Tearing of the rotator cuff tendon results in instability of the biceps tendon and allows it to move around more than normal, resulting in rubbing on surrounding bony structures. This results in inflammation and tearing of the tendon.

Other common conditions which can also occur with biceps tendinitis include labral tears or arthritis. On the other hand, isolated biceps tendinitis accounts for only 5% of the cases reported. Isolated tendinitis is more common in young throwing athletes, or those who participate in repetitive, high-demand use of the shoulder.

The biceps muscle runs along the front of the upper arm from the elbow to the shoulder. This muscle helps us to flex our arms as well as twist our forearms outward, turning our palms up. When we talk about biceps tendinitis, it is important to know exactly which tendon we are talking about. In fact, we have 2 biceps tendons at the top of the arm. One is referred to as the long head of the biceps tendon, and the other, the short head of the biceps tendon. Both tendons help connect the biceps brachii muscle to the shoulder but at different locations.

When we refer to upper, or proximal, biceps tendinitis, we are talking about the long head of the biceps. The long head of the biceps tendon originates from the top of the labrum at the socket of the shoulder joint. These 2 structures merge with one another. The biceps tendon then runs through the shoulder joint in front of the ball of the shoulder and then exits into a bony groove referred to as the bicipital groove. There are a number of structures that help keep the long head of the biceps tendon stable within the bicipital groove. Some of these are ligaments, and the others are 2 of the 4 rotator cuff tendons. The transverse humoral ligament fills in between the 2 rotator cuff tendons to provide a little stability as well. You can see how damage to either of these supporting structures may allow the biceps tendon to become unstable and move around, resulting in inflammation.

Patients with biceps tendinitis will often have pain at the front and top portion of the shoulder, sometimes with the pain traveling into the front portion of the upper arm. Some may also have a feeling of the tendon popping in and out of the groove, or rubbing sensations. A provider will perform a physical examination of the affected shoulder. They will look at the shape of the biceps muscle. For example, if there was a complete rupture of the biceps tendon, they will observe what is referred to as a "Popeye" deformity. When the biceps ruptures from the top of the shoulder, the muscle belly then balls up in the upper arm.

The provider will also feel the biceps tendon to see if it is tender to touch. They will also assess for other shoulder conditions likely to occur with biceps tendinitis, like a rotator cuff or labral tear. In addition to physical examination, there are other tools a provider can use to help confirm the diagnosis of biceps tendinitis. They may inject numbing medication near the biceps tendon to see if the patient gets relief. If the patient does not get relief, it is a good indication there is another condition in the shoulder causing the pain.

Ultrasound can also be used to evaluate how the biceps moves when the shoulder is taken through different motions. Lastly, an MRI is often obtained to evaluate for other shoulder conditions, but it can also help provide a better picture of the biceps tendon too. After a full evaluation, the provider will take all factors into consideration and discuss treatment plan options with the patient.