Biceps Tendinitis

Biceps tendonitis is an overuse injury that affects the long head of the biceps tendon. It often develops gradually, as repetitive shoulder movements place excessive strain on the tendon, leading to inflammation, microtears, and pain. Over time, chronic inflammation can lead to tendon thickening, degeneration, or even partial tears, making early diagnosis and management essential.

1. Overuse and repetitive activities – swimming, baseball, tennis, and weightlifting frequently involve repetitive overhead arm movements, placing stress on the biceps tendon.
2. Aging and degeneration – as we age, the tendons in the body naturally weaken and become more prone to inflammation and tears.
3. Rotator cuff dysfunction – biceps tendonitis often occurs alongside rotator cuff injuries. When the rotator cuff is compromised, the biceps tendon may take on additional stress.
4. Shoulder instability – chronic shoulder instability, caused by previous shoulder dislocations or ligament laxity, can lead to increased strain on the biceps tendon.
5. Poor mechanics and posture – improper shoulder mechanics or posture, particularly in overhead sports, can place excessive tension on the biceps tendon, contributing to inflammation.
6. Trauma or acute injury – a direct blow to the shoulder or a sudden forceful movement can damage the biceps tendon, leading to acute inflammation and pain.

Biceps tendonitis often presents with pain and discomfort in the front of the shoulder. Common signs include:

• Pain in the front of the shoulder – a deep, aching pain along the front of the shoulder, which may worsen with overhead activities.
• Tenderness over the biceps tendon – pressing on the front of the shoulder may cause localized tenderness.
• Weakness in the shoulder – when lifting or rotating the arm.
• Swelling – in the shoulder area.
• Pain that radiates down the arm – toward the elbow, especially with repetitive motion.
• Clicking or snapping sensation – when moving the arm.
• Stiffness and limited range of motion – inflammation can cause discomfort when moving the shoulder, particularly when reaching overhead or behind the back.

Biceps tendonitis can occur with damage to the rotator cuff and other shoulder conditions such as shoulder impingement, arthritis, and shoulder instability. Untreated biceps tendonitis may progress to more severe conditions, such as partial or complete tendon tears, requiring more extensive treatment.

Dr. Stephanie Boden will perform a comprehensive evaluation including a detailed medical history, physical examination, and imaging studies to confirm the diagnosis and rule out other shoulder conditions.

Medical history

Dr. Boden will ask about the patient’s symptoms, activity level, previous injuries, and any repetitive movements that may contribute to shoulder pain. Understanding the nature of the pain and any aggravating or relieving factors helps guide the diagnosis.

Physical examination

The examination focuses on assessing pain, tenderness, and shoulder function. Specific clinical tests help identify biceps tendonitis.

Imaging studies

Diagnostic imaging helps confirm the diagnosis and assess the severity of the condition:

• X-rays – while x-rays do not show soft tissues like tendons, they can identify bone abnormalities, such as arthritis or shoulder impingement, that may contribute to biceps tendonitis.
• Ultrasound – a dynamic ultrasound allows real-time visualization of the biceps tendon, identifying inflammation, thickening, or partial tears.
• MRI – an MRI provides detailed images of the soft tissues in the shoulder, allowing for a comprehensive evaluation of the biceps tendon, rotator cuff, and surrounding structures.