Biceps Tendonitis of the Shoulder
Long head of Biceps Tendon Anatomy
The biceps muscle has 2 tendons in the proximal origin. They are the long head which goes into the shoulder joint and attaches to the superior glenoid and the short head which inserts into the coracoid process.
The long head of biceps tendon is a common cause of shoulder pain.
Where is the Usual Area of Pain if it is Due to Biceps Tendonitis?
Biceps tendonitis is an inflammation of the long head of biceps tendon. The pain is usually localised to the front of the shoulder joint.
What Causes Biceps Tendonitis?
- Overuse – repeated overhead activities of the shoulder joint.
- Sports – lifting weights, tennis, badminton, free-style swimming.
- Degenerative – osteoarthritis, rotator cuff tendon tear, labral tear.
What are the Usual Symptoms?
- Pain in the front of the shoulder.
- Pain when lifting the shoulder above 90 degrees.
- Occasionally there may be snapping of the tendon.
- Weakness of the biceps.
- If left untreated, it can often progress to frozen shoulder (adhesive capsulitis).
What are the Clinical Examination findings?
Pain on palpation of the long head of biceps tendon over the front of the shoulder (bicipital groove).
Speed’s test – The shoulder is forward flexed to 90 degrees with the elbow in full extension and hand facing the sky (supinated). The examiner presses the arm downwards while the patient resists. This is then repeated with the hand facing the ground (pronated). It is considered positive if there is significantly more pain with the hand facing up (supinated) than facing down (pronated).
What Investigation Can Help?
MRI scan of the shoulder is useful for diagnosis. It can show fluid surrounding the tendon indicating inflammation.
How to Treat?
- Rest the shoulder joint. Stop the repetitive activities causing the injury e.g. lifting dumb-bells, free-style swimming.
- Oral anti-inflammatory medications.
- Steroid injection to the sheath surrounding the long head of biceps tendon in the bicipital groove. There is a risk of rupture of the tendon post-injection and patient should be informed. The risk is low.
- Physiotherapy may help.
- Surgery may be needed if the pain does not resolve.
Surgery for Biceps Tendonitis:
Arthroscopic tenotomy of the inflamed tendon at the insertion to the superior glenoid. This may result in a Popeye’s deformity of the biceps muscle just above the elbow joint. It is a reasonable option for more elderly patients who are not too concerned about biceps cosmesis.
Biceps tenodesis – This is a surgical procedure where the long head of biceps tendon is cut at the level of the insertion to the superior glenoid and the tendon delivered out through an open incision near to the arm-pit and the tendon end implanted into the upper arm bone (humerus).