Bicep Tendonitis in Boise

What Is Bicep Tendonitis?

The biceps muscle is located in the front of your upper arm. It is attached to the bones of the shoulder by two tendons called the proximal biceps tendons. The long head of the biceps tendon attaches to the top of the shoulder socket (glenoid) and travels through the shoulder joint and into a groove in the upper arm bone (humerus). The short head attaches to a bump on the shoulder blade called the coracoid process. Bicep tendonitis is an inflammation or irritation of the upper biceps tendon, most commonly affecting the long head. This condition causes pain in the front of the shoulder and upper arm and is a common source of shoulder discomfort, particularly among active individuals and those who perform repetitive overhead motions.

Causes of Bicep Tendonitis

Bicep tendonitis typically develops over time due to repetitive use and wear on the tendon. Several factors can contribute to the development of this condition:

• Repetitive overhead activities — Sports such as swimming, tennis, and baseball, or occupations that require frequent overhead reaching and lifting can place excessive stress on the biceps tendon.
• Age-related degeneration — As we age, the tendons naturally lose elasticity and develop degenerative changes, making them more susceptible to inflammation and injury.
• Rotator cuff injuries — Bicep tendonitis frequently occurs alongside rotator cuff tears and other shoulder conditions. When the rotator cuff is damaged, the biceps tendon often takes on additional stress.
• Shoulder impingement — When the space between the top of the shoulder blade (acromion) and the rotator cuff narrows, the biceps tendon can become pinched and irritated.
• Shoulder instability — Looseness in the shoulder joint can place extra strain on the biceps tendon as it works to help stabilize the joint.

Symptoms of Bicep Tendonitis

The most common symptoms of bicep tendonitis include:

• Pain in the front of the shoulder that may radiate down the upper arm
• A deep, aching pain that worsens with overhead activities or lifting
• Tenderness when pressing on the front of the shoulder at the bicipital groove
• Pain that intensifies when raising the arm overhead or reaching behind the back
• Weakness in the shoulder, particularly with rotating the forearm or bending the elbow
• A snapping or clicking sensation in the shoulder during movement
• Pain that may worsen at night, especially when lying on the affected shoulder

Diagnosis of Bicep Tendonitis

A thorough evaluation by a shoulder specialist is essential for accurate diagnosis. During the examination, your doctor will assess your shoulder’s range of motion, strength, and stability. Specific physical examination tests, such as the Speed’s test and Yergason’s test, are used to reproduce symptoms and help confirm the diagnosis. Imaging studies including X-rays can identify bone spurs or other bony abnormalities that may be contributing to the condition. Magnetic resonance imaging (MRI) provides detailed images of the soft tissues and can reveal inflammation, partial tears, or subluxation (displacement) of the biceps tendon from its groove. In some cases, an ultrasound may be used to evaluate the tendon dynamically during movement.

Non-Surgical Treatment Options

Most cases of bicep tendonitis respond well to conservative, non-surgical treatment. The initial approach typically includes:

• Rest and activity modification — Avoiding activities that aggravate symptoms allows the tendon to heal. Your doctor may recommend temporarily limiting overhead movements and heavy lifting.
• Ice therapy — Applying ice to the front of the shoulder for 15-20 minutes several times a day can reduce pain and inflammation.
• Non-steroidal anti-inflammatory medications (NSAIDs) — Medications such as ibuprofen or naproxen can help relieve pain and reduce inflammation.
• Physical therapy — A structured rehabilitation program focusing on stretching and strengthening exercises helps restore flexibility, improve posture, and strengthen the muscles that support the shoulder.
• Corticosteroid injections — An injection of cortisone into the area around the biceps tendon can provide significant short-term relief from pain and inflammation.

Surgical Treatment Options

When non-surgical treatments fail to provide adequate relief after several months, or when there is significant damage to the biceps tendon, surgery may be recommended. Surgical options include:

• Biceps tenodesis — This procedure involves detaching the damaged portion of the biceps tendon from its attachment inside the shoulder and reattaching it to the upper arm bone (humerus). This is often the preferred procedure for active patients and younger individuals, as it preserves arm strength and helps prevent muscle cramping.
• Biceps tenotomy — In this procedure, the damaged long head of the biceps tendon is simply released from its attachment point. The tendon retracts down the arm, and the short head of the biceps continues to function. This is a simpler procedure with a faster recovery but may result in a slight cosmetic deformity (a “Popeye” bulge in the upper arm) and mild cramping with heavy use.

Both procedures can be performed arthroscopically through small incisions, resulting in less pain, less scarring, and a faster recovery compared to open surgery. The choice between tenodesis and tenotomy depends on the patient’s age, activity level, cosmetic concerns, and the extent of tendon damage.

Recovery After Bicep Tendonitis Treatment

Recovery from non-surgical treatment typically takes 6 to 12 weeks with consistent adherence to the treatment plan. After surgical treatment, recovery varies depending on the procedure performed. Following a biceps tenodesis, the arm is typically immobilized in a sling for 4 to 6 weeks to allow the tendon to heal to the bone. Physical therapy begins gradually and progresses over 3 to 4 months. Most patients return to full activity by 4 to 6 months after surgery. Recovery after a tenotomy is generally faster, with most patients returning to light activities within a few weeks.

When to See a Shoulder Specialist

If you are experiencing persistent pain in the front of your shoulder that does not improve with rest, or if you notice weakness, snapping, or difficulty performing daily activities, it is important to seek evaluation from a qualified shoulder specialist. Early diagnosis and treatment of bicep tendonitis can prevent the condition from worsening and help you return to the activities you enjoy. Contact our office to schedule an appointment and take the first step toward relief.