Is Bicep Tendonitis
Causing Your Shoulder Joint Pain?


Bicep Tendonitis may not be the first tendon you think of when it comes to shoulder joint pain. Do you know the difference between bicep and rotator cuff tendonitis? What can you do if the bicep tendon is the source of your pain?



What is Bicep Tendonitis?

Although bicep tendonitis sounds like a condition of the elbow, it actually is a condition of the shoulder. A tendon connects muscle to bone. The superior or upper aspect of the biceps actually splits into two tendons that attach to the shoulder blade or scapula. The biceps helps to support the anterior or front of the shoulder. The long head of the biceps attaches into the labrum of the shoulder. The short head of the bicep attaches to the coricoid process of the scapula.

As a whole, the biceps functions to flex/bend the elbow, supinate or rotate the forearm, and flex the shoulder. The long head of the biceps tendon also functions to help assist the rotator cuff in adding stability to the anterior aspect of the shoulder.


Biceps tendonitis


Tendonitis in general means inflammation of a tendon thus biceps tendonitis is inflammation of the long biceps tendon. Although the biceps tendon can become inflamed, frequently pain in the tendon occurs without inflammation. When this occurs, pain in the tendon is referred to as tendinopathy.


Typical Causes

Overuse is the most common cause of tendonitis. The same is true with the bicep tendon. However, because of the complex mechanics of the shoulder, overuse of the rotator cuff can have a negative impact on the biceps tendon. Weakness and or inflammation of the rotator cuff can cause the biceps tendon to work more to help stabilize the shoulder, increasing the opportunity for inflammation. Overhead activities such as throwing and swimming are more commonly associated with biceps tendonitis secondary to the significant activity of the rotator cuff and need for dynamic stability of the shoulder.


Another potential cause of this condition is related to shoulder mobility. The capsule of the shoulder assists in providing stability to the joint. In cases in which the posterior aspect of the capsule becomes tight, anterior tension on the shoulder can occur, putting more stress on the bicep tendon.


Typical Symptoms

The most common symptom of this type of tendonitis is pain over the anterior shoulder. Symptoms generally occur when raising the arm over shoulder height. Functional activities such as reaching behind the back to tuck in a shirt, reaching overhead into an upper cabinet, and sleeping on the involved side is often painful. Of course, pain with throwing can also occur.



Conservative Treatment Protocol

As with all painful joint conditions, treatment goals include first, reducing inflammation, second, restoring normal range of motion, and finally, restoring strength and function.

Reducing inflammation can be achieved through a number of means. First, the use of ice therapy is a must. Icing the shoulder 10 to 15 minutes a few times a day is a safe means of reducing inflammation. The use of ice massage is specifically helpful with bicep tendonitis as the tendon is rather superficial. To use ice massage, fill a Styrofoam cup with water and freeze it. Peel off the top of the cup exposing the ice. Massage the front of the shoulder for 5 minutes.


shoulder ice massage


Oral anti-inflammatory medications are frequently prescribed to reduce tendon inflammation. There are also some anti-inflammatory creams that are effective in treating inflammation of superficial structures such as the tendons of the shoulder (consult your doctor regarding medications). Although cortisone injections are not uncommon with treating rotator cuff tendonitis or bursitis, it is generally not recommend when the biceps tendon alone is the cause of shoulder inflammation.

Another key component to reducing inflammation is to avoid painful activities. Avoid throwing activities, minimize sleeping on the painful side, and limit overhead movements.


Physical Therapy

Tendons that become inflamed often become stiff and lose flexibility. In addition, because of the relationship of the shoulder capsule tightness with tension on the anterior shoulder, stretching of the capsule is often required. Shoulder stretching exercises are thus an important part in the overall treatment plan.

Restoring shoulder strength is also a key to restoring pain free motion and reducing the risk of the symptoms returning. Because of the relationship between the bicep tendon and the rotator cuff, strengthening of the rotator cuff must be a component to successful treatment.

The following is a list of typical stretching and strengthening exercise for the treatment of bicep tendonitis: Bicep Tendonitis Exercises.

In addition to exercise, other physical therapy treatments can be greatly beneficial in reducing biceps tendon pain. Cross friction massage, or deep massage across the tendon, can be helpful in improving tendon mobility and healing. Modalities, including ultrasound, phonophoresis, and iontophoresis can help reduce local inflammation and improve healing.

If you believe you might have biceps tendonitis, consider seeking physical therapy as part of your conservative treatment plan.


Summary


• The bicep tendon assists the rotator cuff in providing stability to the anterior shoulder.

• Tendonitis of the bicep is often related to the rotator cuff. Weakness of the rotator cuff or general stiffness of the shoulder can help create bicep stress.

• Common symptoms include anterior shoulder joint pain with reaching overhead, throwing, or reaching behind the back.

• Conservative treatment includes ice therapy , ice massage, anti-inflammatory medication, and physical therapy.

• To improve shoulder mobility and strength related to bicep tendontitis, follow this exercise program: Bicep Tendonitis Exercises.

Bicep tendonitis is treatable condition of the shoulder. Follow the recommendations and get on the road to reducing your shoulder joint pain.


References

Arthroscopy. 2011 Apr;27(4):581-92.Anatomy, function, injuries, and treatment of the long head of the biceps brachii tendon.Elser F, Braun S, Dewing CB, Giphart JE, Millett PJ.

Am Fam Physician. 2009 Sep 1;80(5):470-6.Diagnosis and treatment of biceps tendinitis and tendinosis.Churgay CA.

Rheumatology (Oxford). 2006 May;45(5):508-21. Epub 2006 Feb 20.Current concepts in the management of tendon disorders.Rees JD, Wilson AM, Wolman RL.


Return to Top

Return to Shoulder Joint Pain Home