Biceps Tendonitis

The word biceps comes from the Latin words bi (meaning “two”) and caput (meaning “head”; the same root as the word for capital). The biceps muscle is formed by separate tendons, or heads, which converge to form one muscle.

The two heads are known as: the long head and short head. The long head originates just above the socket of the shoulder joint, which is a ball and socket joint. This tendon then passes through the joint of the shoulder and into a groove in the arm bone, known as the bicipital groove.

Biceps tendinitis is inflammation of the long head of the biceps tendon either within the shoulder joint and/or within the bicipital groove. As the shoulder moves or the biceps muscle is flexed, the inflamed biceps tendon rubs within the joint and/or within the groove causing pain.

Signs & Symptoms:

Patients with biceps tendinitis typically report a history of gradually worsening shoulder pain; the pain is typically located on the front of the shoulder and radiates down the arm in line with the course of the biceps muscle. Usually there is no history of an acute injury. The pain is often worse with certain movements, including reaching behind the back and resisted elbow flexion (ie biceps curls).

Biceps tendinitis is also frequently associated with other shoulder pathology, including rotator cuff tears and impingement syndrome. The symptoms associated with these conditions can make the diagnosis of biceps tendinitis confusing and somewhat difficult.

Diagnosis:

The diagnosis of biceps tendinitis is typically made by a combination of the patient’s history and the findings on physical examination. X-rays are frequently obtained to rule out other sources of shoulder pain, but are usually normal in the setting of isolated biceps tendinitis. An MRI scan may show abnormalities of the biceps tendon and associated shoulder pathologies, but it is often normal in the setting of isolated biceps tendinitis.

Treatment:

The treatment of biceps tendinitis is usually non-operative initially. Typically a conservative treatment approach including anti-inflammatory medications, activity modification, icing, and physical therapy is recommended. If this initial conservative approach fails, a steroid injection may be performed. The injection does increase the risk for rupturing the biceps tendon, however.

If the injection fails to provide significant or lasting relief, surgical treatment may be considered. During surgery, the biceps tendon is evaluated. Surgical treatment options include:

1) Biceps debridement: removing inflamed tissue and leaving remainder of the healthy biceps intact;

2) Biceps tenotomy: cutting and releasing the long head of the biceps tendon so that it no longer rubs within the joint and within the groove causing pain; or

3) Biceps tenodesis: cutting the tendon at its origin and reattaching it further down the arm within the bicipital groove so that it no longer rubs within the joint and within the groove causing pain.