Bicep Tendonitis Symptoms: An In-Depth Guide to Understanding and Managing Pain

Michelle Labonia
An image of a person suffering from bicep tendonitis symptoms.

Understanding Bicep Tendonitis and Its Impact

A painful condition that affects shoulder and arm movement, as well as sleep, biceps tendonitis (also known as tendinitis) arises when there is inflammation to one of the biceps tendons – typically the long head (upper) tendon that attaches to the top of the shoulder.

Caused by overuse or trauma and often seen in sports and professions that involve repetitive overhead activity, the condition commonly occurs alongside shoulder injuries and dysfunction.

According to the American Academy of Orthopaedic Surgeons, biceps tendinitis will often be present when there is damage to the rotator cuff tendons. In the Studio, we often see it in patients with rotator cuff injuries, shoulder instability, labral (shoulder fibrocartilage) tears and arthritis.

The good news? While steroid injections or surgery may be required in severe cases, bicep tendinitis tends to respond well to treatment. A combination of rest, pain management, physical therapy and exercise can often get you back on track in a few weeks.

For everything you need to know about biceps tendonitis symptoms, causes, treatment and prevention, read on. We’ve covered all the bases in this comprehensive article.

Recognising the Early Signs of Bicep Tendonitis

Common symptoms of biceps tendinitis include the following:

  • Pain: Typically located at the front of the shoulder and may extend down the arm.
  • Swelling: Inflammation of the tendon can lead to localised swelling.
  • Tenderness: The affected area may be tender to the touch.
  • Weakness: Some individuals may experience weakness in the affected arm.
  • Pain with overhead activities: Pain may increase with movements that involve raising the arm overhead.

One of the first signs of biceps tendinitis is often pain when sleeping on the affected shoulder. Patients will typically experience pain in the front of the shoulder, especially when lifting or performing overhead movements such as pulling on a jumper or putting on a jacket. There will be pain and/or weakness with shoulder flexion, ie. when lifting the arm forward and above the head.

Other symptoms may include swelling and tenderness in the shoulder and upper arm, pain radiating to the elbow, pain and/or weakness when bending the elbow, pain on reaching into the back seat of the car and a clicking noise accompanying shoulder movement in the affected arm.

A partial or complete tear of the biceps tendon, on the other hand, is usually accompanied by a sudden, severe pain at the shoulder or elbow. You may also hear a popping sound when a biceps tendon rupture occurs, and bruising may appear on the upper arm.

Types of Biceps Tendonitis

There are two types of biceps tendonitis. However, we most often talk about the more common proximal biceps tendonitis. This involves inflammation of the long (upper) head of the biceps tendon, which connects the biceps muscle to the shoulder. Distal biceps tendinitis, on the other hand, involves inflammation of the distal (lower) end of the biceps tendon, located near the elbow.

What Causes Biceps Tendonitis? Key Risk Factors Explained

To understand the causes of biceps tendinitis, we need to look more closely at the biceps muscle. Made up of a short head and a long head, the biceps muscle is situated in the front of the upper arm between the shoulder and elbow.

The short head attaches to the top anterior (front) portion of the shoulder. The long head passes through a groove at the front of the shoulder, through the shoulder joint and attaches at the top of the shoulder, making it more susceptible to inflammation and injury. Hence, we see a much greater proportion of proximal versus distal biceps tendinitis in the clinic.

Pain, weakness and poor biomechanics of the shoulder joint can often trigger biceps tendinitis by placing excessive load on the muscle. For this reason, symptoms often present in patients with injuries to the rotator cuff (muscles on the back and top of the shoulder that provide stability to the shoulder joint) and/or shoulder instability.

Additionally, biceps tendinitis is most often brought about by repetitive overhead motion. For instance, it is regularly seen in athletes involved in sports that require overhead activities, such as baseball (pitching), tennis (serving), and swimming. Those in jobs that require overhead activity and lifting (eg. painters and builders) are also at risk of a damaged biceps tendon.

In some instances, biceps tendinitis occurs as a result of trauma. Whereas tendinosis – chronic, non-inflamed tendon discomfort due to degeneration – can be a problem for the older population.

An image showing biceps tendon anatomy for bicep tendonitis.

Effective Treatment Strategies for Biceps Tendonitis

Treatment strategies for biceps tendon injuries or tendonitis often involve a combination of rest, ice, anti-inflammatory medications and physiotherapy, including strengthening exercises. In more severe cases, a healthcare provider may recommend corticosteroid injections to reduce inflammation of the injured tendon and relieve pain.

In the case of severe tendonitis or a biceps tendon tear, surgery may be an option to repair the damaged tendon.

If you are experiencing pain in the upper arm or shoulder, have a reduced range of motion or weakness or clicking in the shoulder joint (especially with overhead actions), it’s essential to consult with a healthcare professional. They will provide an accurate diagnosis and appropriate treatment plan based on the degree of inflammation or damage to the bicep tendons.

Exercises to Alleviate and Prevent Biceps Tendonitis

Engaging in targeted exercises can be instrumental in alleviating the symptoms of biceps tendonitis and protecting the biceps tendon from future damage. Effective exercises include:

Rotator Cuff Strengthening: Strengthening the rotator cuff muscles helps stabilise the shoulder joint. External and internal rotation exercises with resistance bands or light weights can be beneficial.

Video Source: Physitrack

Scapular Stabilisation Exercises: Improving the stability of the shoulder blade can reduce strain on the biceps tendon. Exercises such as shoulder blade retractions and squeezes can help.

Range of Motion Exercises: Gentle range of motion exercises help maintain flexibility in the shoulder joint. These may include pendulum exercises and passive shoulder stretches.

Video Source: Physitrack

Posture Correction: Addressing poor posture can alleviate stress on the shoulder joint. Exercises focusing on improving posture, such as shoulder blade squeezes and chin tucks, can be beneficial.

How Physiotherapy Can Help with Bicep Tendonitis

If you are suffering from tendonitis, have a biceps tendon injury or shoulder pain, physiotherapy can be very beneficial. Your physio will first take a thorough history of your injury and assess the range of motion, strength and function of your neck, shoulder and thoracic spine to rule out other potential pathologies.

Further investigation of the biceps muscle may be required in the form of an ultrasound or MRI.

If there is inflammation of the biceps tendon (tendonitis), the first stages of treatment will typically include anti-inflammatories, ice and rest. Patients with acute biceps tendinitis – as well as the chronic, non-inflamed condition, tendinosis – will need physiotherapy combined with a strengthening program.

To rehabilitate the area and prevent biceps tendinitis from recurring, it is important to strengthen the shoulder muscles and scapula (shoulder blade) stabilising musculature and improve posture and neck and thoracic (upper back) flexibility. Your physiotherapist will provide you with strengthening exercises and educate you on how to improve your lifting/overhead technique to protect your biceps tendons.

Explore More: Comprehensive Guides and Research on Tendonitis

Want to know more about biceps tendon injury? Visit Medical News Today for further information on the causes, symptoms and treatments for tendonitis, including surgery, as well as how it differs from chronic tendinosis.

Or try these WebMD-approved exercises to keep your shoulder and bicep flexible while you allow the tendon sheath to heal.

Experiencing symptoms of biceps tendonitis? Don’t wait for relief. Book an appointment with our expert physiotherapists today for personalised care and effective treatment strategies. Click here to schedule your consultation or call us on 9650 2220 to get your rehabilitation underway.