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Biceps Tendinitis

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. Pain in the front of the shoulder and weakness are common symptoms of biceps tendonitis. They can often be relieved with rest and medication. In some cases, surgery is necessary to repair the tendon.


Why is my biceps tendon inflamed?

Continuous or repetitive shoulder actions can cause overuse of the biceps tendon. Damaged cells within the tendon don’t have time to recuperate. The cells are unable to repair themselves, leading to tendonitis. 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.
Biceps tendonitis usually occurs along with other shoulder problems. In most cases, there is also damage to the rotator cuff tendon.

Other problems that often accompany biceps tendonitis include:

  • Arthritis of the shoulder joint
  • Tears in the glenoid labrum
  • Chronic shoulder instability
  • Shoulder impingement
  • Other diseases that cause inflammation of the shoulder joint lining
    In the early stages of biceps tendonitis, the tendon becomes red and swollen. As tendonitis develops, the tendon sheath (covering) can thicken. The tendon itself often thickens or grows larger.
    The tendon in these late stages is often dark red in color due to the inflammation. Occasionally, the damage to the tendon can result in a tendon tear, and then deformity of the arm (a “Popeye” bulge in the upper arm).


What does biceps tendonitis feel like?

  • Deep ache in the front of shoulder
  • Arm may feel weak with attempts to bend the elbow or when twisting the forearm
  • Catching or slipping feeling near the top of the biceps muscle

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 Options:

Nonsurgical 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. Resting the shoulder relieves pain and calms inflammation.
Anti-inflammatory medicine may be prescribed to ease pain and to help patients return to normal activity. These medications include common over-the-counter drugs such as ibuprofen.

Doctors may have their patients work with a physical or occupational therapist. Therapists apply treatments to reduce pain and inflammation. When present, conditions causing the biceps tendonitis are also addressed. For example, 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. When needed, therapists also evaluate the way you do your work or sport activities to reduce problems of overuse.
In rare instances, an injection of cortisone may be used to try to control pain. Cortisone is a very powerful steroid. However, cortisone is used very sparingly because it can weaken the biceps tendon, and possibly cause it to rupture.


Patients who are improving with conservative treatments do not typically require surgery. Surgery may be recommended if the problem doesn’t go away or when there are other shoulder problems present.