Patient Education

Tendonitis of the long head of the biceps, also known as biceps tendonitis or proximal biceps tendonitis, is an inflammation or irritation of the long head tendon that connects the biceps muscle to the shoulder socket (glenoid).

Common Symptoms

• Pain in the front of the shoulder, which may radiate down the upper arm
• Tenderness over the biceps tendon
• Weakness or difficulty with overhead activities
• Clicking, snapping or catching sensation with shoulder movements
• Swelling or bruising in the biceps area

Cause & Anatomy

The most common cause is overuse or repetitive overhead motions that put excessive stress on the biceps tendon, such as in sports like baseball, swimming, tennis, and weightlifting. Other causes include acute injury, poor biomechanics, and age-related degeneration of the tendon.

The biceps muscle has two tendons – the long head and the short head. The long head tendon attaches the biceps muscle to the top of the shoulder socket (glenoid) and runs through the shoulder joint. This makes it susceptible to inflammation and injury from overuse or impingement.

Diagnosis

Diagnosis is typically made through a physical examination, where the doctor will check for tenderness, pain with specific movements, and weakness. Imaging tests like X-rays, MRI, or ultrasound may be ordered to rule out other conditions or assess the severity of tendon damage.

Prevention

• Proper warm-up and stretching before activities
• Avoiding overuse or excessive overhead motions
• Maintaining good posture and biomechanics
• Strengthening shoulder and rotator cuff muscles
• Taking breaks and allowing adequate rest between workouts

Treatment

Non-surgical treatments are usually tried first:

• Rest and activity modification
• Ice application to reduce inflammation
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Physical therapy exercises to stretch and strengthen the biceps and shoulder muscles
• Corticosteroid injections to reduce inflammation (short-term relief)
• Platelet-rich plasma (PRP) injections to promote healing

Surgery

Surgery may be recommended if non-surgical treatments fail to provide relief or if there is a complete tear of the biceps tendon. The most common surgical procedures are:

• Biceps tenodesis: The damaged tendon is detached from the shoulder and reattached to the humerus (upper arm bone).
• Tenotomy: The damaged tendon is released and allowed to retract into the arm.

Rehabilitation

After surgery, a period of immobilization is required, followed by a gradual rehabilitation program involving:

• Range of motion exercises
• Strengthening exercises for the biceps, shoulder, and rotator cuff muscles
• Activity-specific exercises to prepare for return to sports or activities
• The rehabilitation process typically takes 3-6 months, depending on the procedure and individual progress.

FAQ’s

How long does it take for biceps tendonitis to heal?
With proper rest and treatment, most cases of biceps tendonitis resolve within 6-12 weeks. However, severe cases or those with partial tendon tears may take longer to heal.

Can I still exercise with biceps tendonitis?
It’s important to avoid activities that aggravate the pain or put stress on the biceps tendon during the initial healing phase. Low-impact exercises like cycling or swimming may be allowed, but consult your doctor or physical therapist for specific recommendations.

Can biceps tendonitis lead to a complete tear?
Yes, if left untreated or if the tendon is subjected to continued stress, biceps tendonitis can progress to a partial or complete tear of the tendon, which may require surgical intervention.

How can I prevent biceps tendonitis from recurring?
Maintaining good shoulder and arm strength, practicing proper technique in sports or activities, allowing adequate rest and recovery time, and avoiding excessive overhead motions can help prevent recurrence of biceps tendonitis

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