The biceps muscle in front of the upper arm connects to the shoulder bones via two tendons. The upper tendon, also called the long head of the biceps, can become inflamed or irritated with overuse or age leading to pain and weakness. This condition is called biceps tendinitis. Biceps tendinitis can occur with sports and job-related activities that involve repetitive overhead arm movements. Wear and tear of the tendon can also accumulate with age.
The tendon initially becomes red and swollen and its sheath covering gradually starts to thicken. As the condition progresses, the entire tendon thickens and grows larger and dark red. It may occasionally tear leading to a bulge in the upper arm. Pain is felt along the front of the shoulder or upper arm and worsens with overhead activities. An occasional snapping sensation may also be present. Biceps tendinitis may occur along with other conditions such as rotator cuff tear, osteoarthritis, or shoulder instability (dislocation).
When you present to the clinic, your doctor will review your symptoms and history and perform a physical examination to evaluate the range of motion, strength and stability of the shoulder. Specific tests are performed the examine the biceps. Imaging studies such as X-rays or an MRI may be ordered to view the biceps, the shoulder joint and associated muscles. Your doctor will first treat biceps tendinitis by nonsurgical methods which include rest, ice and anti-inflammatory medications. Steroid injections are administered for more effective pain relief. Physical therapy helps stretch and strengthen the biceps and other muscles of the shoulder joint. Surgery is advised when your condition does not improve or when other conditions such as a rotator cuff tear are present.
Surgery is usually performed through an arthroscope (viewing tube) using miniature instruments but may sometimes require an open incision. The damaged section of the biceps tendon is either repaired or removed with reattachment of the remaining tendon to the upper arm bone (tenodesis). In severe cases where repair or tenodesis is not possible, the damaged tendon is simply released from its attachment (tenotomy) to relieve symptoms. Following surgery, you will be in a sling for a few weeks and a rehabilitation program is recommended to help you regain normal function and range of motion of the shoulder.