Biceps tendonitis is inflammation of a strong tendon – called the biceps tendon – that connects the biceps muscle in the upper arm to the bones of the shoulder and elbow.
Inflammation usually occurs at the upper end of the biceps tendon with pain felt at the shoulder. Additional symptoms of biceps tendonitis include tenderness and difficulty moving the arm. For example, it may be hard to raise your arm overhead. You may also hear or feel a snapping or popping sensation in the upper arm or shoulder.
Like most cases of tendonitis, biceps tendonitis is most commonly caused by repetitive strain – in this case, by repeated overhand motions (when the arm passes above shoulder level). This commonly occurs in sports like swimming, tennis, and baseball but also affects people in certain occupations like painters and carpenters who constantly raise and lower their arms for work.
In the early stages of tendonitis, the tendon becomes irritated and inflamed. As the condition progresses, the sheath covering the tendon may also thicken in response to the irritation. Further progression can result in a dark bruise appearing on the upper arm.
If the biceps tendon tears, it can result in a noticeable deformity, nicknamed the “Popeye bulge” in which the muscle usually seen when flexing the biceps appears closer to the elbow than the shoulder. This is because the torn tendon is not sufficiently pulling the muscle up as it would if it were healthy. Thus, the Popeye bulge of the biceps muscle appears to sag toward the elbow.
Biceps tendonitis may appear in conjunction with other degenerative and overuse conditions affecting the shoulder such as arthritis, shoulder impingement, chronic shoulder dislocation, or labral tears in the shoulder.
Diagnosis & Treatment
The most commonly used technique to diagnose biceps tendonitis is with a physical exam involving manipulation of the arm and shoulder. This allows your orthopedic physician to observe any issues with range of motion, as well as to identify at which point during movement that symptoms occur. Imaging tests like an X-ray or MRI can reveal whether any additional structural or tissue damage is present such as a rotator cuff injury.
Doctors usually prescribe conservative treatments first, like RICE (rest, ice, compression, and elevation). Corticosteroid injections can help relieve inflammation and reduce pain for patients with biceps tendonitis, along with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen. Physical therapy can help strengthen surrounding tissues. If these measures don’t improve the patient’s condition, surgery may be necessary to repair the damage.
Surgery to repair or re-anchor the biceps tendon at the shoulder is done via arthroscopy, a minimally invasive technique using a smaller incision size and miniature surgical equipment to speed recovery time and lessen any post-surgical pain or scarring. Even so, recovery can take approximately 3 to 6 months before you’re able to resume pain-free activity and range of motion.
If you have recently injured your shoulder and feel symptoms of what might be biceps tendonitis – such as pain when raising your hand or rotating your arm – call the Center for Orthopaedic Surgery and Sports Medicine by calling (210) 692-7400. You can also request an appointment online. Time is a crucial factor with tendon injuries as scar tissue can form, making a bad situation worse, so don’t wait to contact a properly trained orthopedist today.