Biceps tendinitis is actually a quite common cause of shoulder pain and shoulder impingement (compression of tissue with movement). Biceps tendon inflammation (tendinitis) tends to happen to individuals who do lots of repetitive, over-the-head movements.

It also tends to be a wear-and-tear (ie happens over a period of time), typically with aches and pains just right at the front of the shoulder which gets worse with activity.

What’s biceps tendinitis?

Tendinitis refers to painful inflammation that gets worse at the tendon, causing aches and pains. In this case, biceps tendinitis refers to the tendons of the biceps, one that is at the shoulder and another at the elbow.

Our biceps tendon has 3 sides:

• the long biceps head
• the short biceps head
• the inserting into the forearm

The long head of the biceps is the one that is most commonly affected by tendinitis, as the tendon from the muscle runs up the length of the arm and attaches to the labrum (a rim of cartilage) and the shoulder blade in the shoulder joint.

These types of tendinitis tends to happen when there is excessive, abnormal forces are applied across the tendon, such as

• tension (pulling of the muscle and tendon)
• compression (squeezing, crushing)
• shearing (resistive friction).

When the tendon is subjected to repetitive stresses, it can become damaged, leading to it being irritated, swollen, and painful.

Bicep tendinitis factors

There are many factors that may lead to biceps tendinitis, including:

• Activities that need repetitive overhead movement of the arms, such as placing dishes in a high cupboard or lifting boxes above the shoulder or the head.
• Rotator cuff injuries and tears
• Weakness in the rotator cuff and muscles of the upper back
• Shoulder joint hypermobility (looseness)
• Shoulder joint stiffness
• Shoulder joint muscle tightness
• Poor body mechanics (how a person controls their body when moving)
• An abrupt increase in an exercise routine (increasing exercise intensity/frequency too fast)
• Age-related body changes
• Other diseases or damage inside the shoulder joint

What does biceps tendinitis feel like?

• Sharp pain in the front of your shoulder when you reach overhead, behind your back, or across your body
• Tenderness at the front of your shoulder, where the tendon is
• Pain that radiate toward the neck or down the front of the arm
• Dull, achy pain at the front of the shoulder, especially during and after activity
• Weakness felt around the shoulder joint, with lifting or carrying objects or reaching overhead
• Sometimes you may feel a “click” or a “catch” of the tendon in the front of the shoulder with movement
• Pain when throwing a ball
• Difficulty with daily activities, such as reaching behind your back to tuck in your shirt, or putting dishes away in an overhead cabinet
• Pain when resting that may become worse at night

How to diagnose biceps tendinitis Diagnosed

The physiotherapist will

• review your medical history
• ask you to describe your shoulder condition
• perform a comprehensive physical exam of your shoulder and upper body

They will assess different measures, such as sensation, motion, strength, and flexibility, and may ask you to briefly perform the activities that cause your pain.

They will also palpate different parts of your shoulder to check which seem to be most consistently painful. Other nearby areas, such as your neck and upper back, also will be examined to determine whether they might be contributing to your shoulder pain.

Imaging techniques, such as an X-ray or MRI, are typically not needed to diagnose biceps tendinitis. However, in the event the physiotherapist suspects there are other conditions possibly present in your shoulder, you may be referred to an orthopedic surgeon for further investigation.

How physiotherapist can help with biceps tendinitis

Once biceps tendinitis has been diagnosed, the physiotherapist will work with you to develop an individualized plan tailored to your specific shoulder condition and your goals. There are many physiotherapy treatments that have been shown to be very effective in treating biceps tendinitis.

• Range-of-motion exercises. Abnormal motion of the shoulder joint may contribute to biceps tendinitis, which needs to be assessed and corrected
• Muscle strengthening exercises. The muscles of the shoulder and upper back work together to allow for normal, coordinated upper-body motion. Based on the way the shoulder joint is designed (a ball-and-socket joint, like a golf ball on a golf tee), there are many directions in which the shoulder may move. Therefore, balanced strength of all the upper-body muscles is crucial to make sure the shoulder joint is protected and is moving efficiently. You’d be prescribed specific exercises to safely strengthen the muscles around your shoulder without causing more pain.
• Manual therapy. Your shoulder joint and surrounding muscles will be carefully mobilized as needed to improve their motion, flexibility, and strength. These techniques can target areas that are difficult to treat on your own.
• Pain management. Such as cold therapy and heat therapy, to aid in pain management, which can reduce the need for medication, including pain meds.

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