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Overview

Biceps tendonitis, also called bicipital tendonitis, is inflammation in the main tendon that attaches the top of the biceps muscle to the shoulder. The most common cause is overuse from certain types of work or sports activities. Biceps tendonitis may develop gradually from the effects of wear and tear, or it can happen suddenly from a direct injury. The tendon may also become inflamed in response to other problems in the shoulder, such as rotator cuff tears, impingement, or instability.

Why it Occurs

Continuous or repetitive shoulder actions can cause overuse of the biceps tendon. This is common in sport or work activities that require frequent and repeated use of the arm, especially when the arm motions are performed overhead. Athletes who throw, swim, or swing a racquet or club are at greatest risk. In addition, years of shoulder wear and tear can cause the biceps tendon to become inflamed. Degeneration in a tendon causes a loss of the normal arrangement of the collagen fibers that join together to form the tendon. When this happens in the biceps tendon, inflammation, or even a rupture of the biceps tendon, may occur.  Biceps tendonitis can happen from a direct injury, such as a fall onto the top of the shoulder. A torn transverse humeral ligament can also lead to biceps tendonitis. If this ligament is torn, the biceps tendon is free to jump or slip out of the groove, irritating and eventually inflaming the biceps tendon.

Symptoms

Patients generally report the feeling of a deep ache directly in the front and top of the shoulder. The ache may spread down into the main part of the biceps muscle. Pain is usually made worse with overhead activities. Resting the shoulder generally eases pain. The arm may feel weak with attempts to bend the elbow or when twisting the forearm into supination (palm up). A catching or slipping sensation felt near the top of the biceps muscle may suggest a tear of the transverse humeral ligament.

Treatment

Whenever possible, doctors treat biceps tendonitis without surgery. Treatment usually begins by resting the sore shoulder. The sport or activity that led to the problem is avoided. Anti-inflammatory medicine may be prescribed to ease pain and to help patients return to normal activity.  Conservative management usually includes working with a physical or occupational therapist.  If present, shoulder impingement may require specialized hands-on joint mobilization, along with strengthening of the rotator cuff and shoulder blade muscles. Treating the main cause will normally get rid of the biceps tendonitis. In some instances, an injection of steroids may be used to try to control pain.