Bicep tendonitis is a condition that often causes shoulder pain and discomfort in your arm. The orthopedic shoulder experts at The Ohio State University Wexner Medical Center in Columbus, Ohio, are experienced in diagnosing and treating this condition. Our goal is to help reduce your pain and improve the use of your arm so you can get back to doing the things you enjoy.
What is bicep tendonitis?
The biceps muscle is located in the front of your arm, and it extends the length of it. There are two tendons at the top of the muscle connecting it to the shoulder and one tendon connecting it to your elbow. These tendons are made up of tough, fibrous tissues.
There is a long head in the biceps tendon, which attaches the muscle to the shoulder socket, and a short head in the biceps tendon, which attaches near the shoulder blade. These two tendons form a “V” shape that connects to the biceps muscle. The long head portion of the tendon can become inflamed and cause pain. This results in bicep tendonitis.
The biceps muscle and tendons help you move your arm and shoulder. When you have bicep tendonitis, you may experience limited mobility, and you may be unable to do activities that you enjoy.
What causes bicep tendonitis?
There are some risk factors that can increase the likelihood of a person developing bicep tendonitis.
One of the biggest risk factors for bicep tendonitis is the overuse and gradual weakening of the tendon. Repetitive motion can also be a contributing factor to the condition. When the tendon is used too much, it can start to wear down and become inflamed, leading to pain and discomfort. Over time, this wear and tear can make the tendon weaker and more prone to injuries.
Athletes and people with certain occupations may be more likely to experience this condition. Repetitive activities like lifting, pulling or throwing can contribute to bicep tendonitis. Bicep tendonitis often occurs alongside other shoulder injuries. These injuries may include:
- Rotator cuff tears
- Arthritis in the shoulder
- Shoulder instability
- Traumatic injury to the shoulder, such as dislocation
While bicep tendonitis may occur with other shoulder conditions, the tendon can also tear or rupture in some cases.
Bicep tendon tears
Some people may experience a bicep tendon tear (rupture). Bicep tendon tears occur when the tendons connecting your biceps muscle to the bones in your shoulder and elbow become torn or damaged.
There are two types of tears, including long head of the bicep tendon tears and distal bicep tears. If the tendon is used too much, it can tear, leading to more severe pain and possibly making it hard to use your arm.
Distal bicep tears happen in the tendon that connects the biceps muscle to the elbow. Just like with regular bicep tears, overuse can weaken the distal tendon and make it more likely to tear.
Long head bicep tendon tears can result in a condition known as “Popeye arm” (also called Popeye deformity). This means that the muscle in the upper arm bunches up and resembles the arm of the cartoon character Popeye. In severe cases, surgery may be needed to fix the tendon and help the arm heal properly.
Bicep tendonitis symptoms
Bicep tendonitis can make your arm hurt and make it hard to move, which can affect what you do every day. If your shoulder hurts, it's important to see your doctor. Symptoms can be different for everyone, but may include:
- Pain in the front of the shoulder and down the biceps muscle
- Pain that is often worse with lifting the arm in front of the body or above the shoulder
- Snapping of the bicep tendon with shoulder motion
- Pain that interferes with daily life, recreation or job activities
- Pain that prevents or disrupts sleep
- General weakness or tenderness around the upper arm or shoulder areas
- “Popeye arm” in the event of rupture
As mentioned, the bicep tendon can rupture, causing pain and deformity of the biceps muscle. In cases of acute rupture, you should have your arm evaluated right away.
How is bicep tendonitis diagnosed?
To diagnose bicep tendonitis, your doctor will perform a physical exam and ask about your medical history. This will include a thorough exam of the arm and shoulder. They will ask you about your injury. There may be tenderness over the biceps during the exam, or pain with certain exam maneuvers.
In addition to a physical exam, your doctor will likely order diagnostic imaging, such as magnetic resonance imaging scans. In some cases, imaging may show other shoulder injuries that are present, including rotator cuff tears. Diagnostic imaging can help your doctor formulate a treatment plan customized to meet your specific needs.
Bicep tendonitis treatment
Bicep tendonitis can be treated in different ways depending on how severe it is. For many people, there are nonsurgical options that can help reduce pain and improve movement. However, if the tendonitis is more serious, surgery might be needed in some cases.
Shoulder and sports medicine experts at the Ohio State Wexner Medical Center will decide the best treatment plan for you.
Nonsurgical treatment
Nonsurgical treatment options for bicep tendonitis may include:
- Rest or activity modification
- Applying ice to the affected area
- Medications including oral steroids or nonsteroidal anti-inflammatory drugs (NSAIDs)
- Cortisone injections in the affected area
- Physical therapy (both home exercises and in-office)
Your doctor may recommend a combination of one or more nonsurgical treatment options.
Surgical treatment
If nonsurgical treatment options don’t work or your condition is too advanced, such as with an acute bicep tendon rupture, you may need shoulder surgery. Surgeons at the Ohio State Wexner Medical Center can perform arthroscopic shoulder surgery. This procedure is minimally invasive and looks directly at the tendons and muscles in your arm and shoulder with a high-resolution camera to see what’s torn or inflamed.
The recovery process for repair surgery includes wearing a sling for four to six weeks and beginning gentle physical therapy two to three weeks after surgery. Physical therapy involves four to six months of therapy to continually strengthen the shoulder.