Biceps Tendonitis

What is biceps tendonitis?

Biceps tendonitis is a painful inflammation of the tendon connecting the biceps muscle to the bones of the shoulder. Biceps tendonitis is usually caused by overuse, especially repetitive throwing-type motions of the arm. It can also be caused by pre-existing shoulder injuries, sudden force or older age.

Symptoms include a throbbing, aching pain in the shoulder that may radiate down the arm. Any throwing, lifting, or pulling movement may produce pain in the shoulder.

The diagnosis is made through physical examination and ultrasound, and possibly with CT scan and/or MRI.

Treatment begins with rest, ice, over-the-counter pain relievers, and physical therapy. It may also include injections of local anesthetic and/or corticosteroids into the biceps tendon sheath. Surgery may be needed in some cases.

You should visit your primary care physician who will coordinate care with a physical therapist. First-line treatments for this condition involve rest from activity, physical therapy, and over-the-counter pain medication.

Symptoms of biceps tendonitis

Symptoms of biceps tendonitis can be categorized by those that affect most people, as well as symptoms of a biceps tendon rupture.

Main symptoms

Main symptoms of biceps tendonitis include the following.

• Shoulder pain: The classic symptom of biceps tendonitis is shoulder pain. The pain is usually located in the front of the shoulder and may travel down the arm. The pain may begin suddenly after an inciting event, but more often develops gradually without a clear trigger. The pain will usually get worse with lifting, pulling, or repetitive overhead motions.
• A "click" heard in the shoulder when lifting the arm: Moving the arm up and down may be painful and the pain may get worse at night. You may feel your shoulder catching or snapping as you move your arm up and down.
• Pain when pushing on the front of the shoulder: The biceps tendon can usually be felt in the front of the upper arm near the shoulder as a stiff band located just above the bicep muscle. In people with biceps tendonitis, pushing on this band may cause pain.

Symptoms of a biceps tendon rupture

Some people with biceps tendonitis may hear a sudden "pop" sound, followed by pain, swelling, and bruising in the shoulder after a forceful event. This can occur if the biceps tendon ruptures, or breaks. The following details may also be present:

• Pain may resolve after the rupture: Sometimes if there was pre-existing biceps tendonitis, the pain may actually feel better right after the tendon rupture.
• "Popeye" arm: You may notice a bulging muscle in the middle of the upper arm that looks similar to the arm of the "Popeye" cartoon character. This is due to the biceps muscle contracting together into a tight space.
• Elbow weakness: In some cases, you may experience weakness in flexing the elbow after this occurs.

Causes of biceps tendonitis

Biceps tendonitis is inflammation of the tendon of the biceps muscle, which is the large muscle on the front of the upper arm that is used to bend the elbow. The biceps muscle splits into two muscle heads that attach to different bones in the shoulder region via fibrous cord-like structures known as tendons. When these tendons become inflamed through a variety of causes, it can cause pain in the shoulder. This can occur due to injury or dysfunction as well as impact or trauma.

Pre-existing injury or dysfunction of the shoulder

This can increase the risk of developing biceps tendonitis. The rotator cuff consists of four muscles in the shoulder. Injuries to these muscles, such as through a repetitive use of the arm in sports or work, can inflame the biceps tendon. Abnormalities of the bones of the shoulder can also increase the risk of injury to the biceps tendon, as the biceps tendon can easily be displaced from its normal position.

Sudden force applied to the arm or shoulder

This includes actions in sports or work and can injure the biceps tendon and lead to biceps tendonitis. Specific actions may be more likely to result in injury to the biceps tendon. Types of actions associated with biceps tendonitis include lowering the body during a pull-up, catching a heavy object that falls suddenly, shoveling heavy snow, or forcibly extending the arm when the elbow is flexed.

Who is most likely to be affected

Biceps tendonitis is more likely to occur in older people because the biceps tendon experiences some degeneration with aging. Due to this degeneration, minor forces are more likely to injure the biceps tendon and cause biceps tendonitis. The biceps tendon is also more likely to rupture in older people due to this degeneration.

Treatment options and prevention for biceps tendonitis

Biceps tendonitis is an acute event, but the treatment can take weeks or months to restore normal function. Therefore, it is important to work with a physician to come up with an appropriate treatment plan.

Rest and pain medication

For people with mild biceps tendonitis, resting the biceps tendon, reducing painful activities, and taking over-the-counter pain medications may be enough to resolve the biceps tendonitis. A physician may recommend resting the arm for five to seven days while taking NSAID medications such as ibuprofen (Advil/Motrin) or naproxen (Aleve). Some people may benefit from a topical pain-relieving gel such as diclofenac.

Physical therapy

Most people with biceps tendonitis will benefit from physical therapy to strengthen the muscles in the shoulder region. The physical therapist can design an exercise routine and help develop a step-by-step plan to gradually return to work and sports activities.

Steroid injections in the shoulder

For people with biceps tendonitis that does not get better with rest and pain medications, steroid injections into the shoulder may help relieve the pain and inflammation. This is usually offered to those who still have pain after six or more weeks of activity modification and conservative treatment. The steroid is usually injected into the shoulder using a needle under the guidance of ultrasound.

Surgery to relieve biceps tendonitis pain or to repair a biceps tendon tear

There are some surgical procedures that can be used to treat pain from biceps tendonitis that is not relieved with medications, although there is not strong evidence that these procedures always help. Surgery is not always required but may prevent the loss of strength that may be associated with a biceps tendon tear. This may be especially important for athletes or people whose jobs require them to do a lot of lifting.

When to seek further consultation for biceps tendonitis

You should go see your physician if you experience shoulder pain, you hear a "click" sound when moving the shoulder, or a "pop" sound after a forceful movement of the shoulder. This is especially important if you engage in sports or work that requires repetitive use of the arm. Your physician can examine your shoulder and possibly order imaging to determine if you have biceps tendonitis. If you are diagnosed with biceps tendonitis, your physician can come up with an appropriate treatment plan for you.