Biceps tendinitis at the shoulder is an irritated long head of biceps tendon, the tendon that runs up the front of your shoulder into the joint. It causes a deep ache at the FRONT of the shoulder, worse lifting, reaching overhead or reaching behind you.
It rarely travels alone.
Most of the time it comes with a rotator cuff problem or a labral tear, so treatment aims at the whole shoulder, not just the biceps.
Most people get better with a few months of exercise and activity changes, sometimes with an injection to calm the pain. Surgery is considered only if that hasn’t worked after about 3 MONTHS.
What the long head of biceps is
- Your biceps has two tendons at the top. The long head is the one that causes trouble at the shoulder
- It runs in a groove at the front of the arm bone, then turns inside the shoulder joint and attaches to the top of the socket
- That route is busy. The tendon passes right next to the rotator cuff, and shares its attachment with the labrum, the rim of cartilage around the socket. When those get irritated or torn, the biceps tendon often does too
- Tendinitis vs tendinopathy: the tendon is often more worn than inflamed, which is why many doctors now say tendinopathy. The treatment is the same
Symptoms
- Pain at the front of the shoulder, often deep and throbbing
- An ache that runs down the front of the upper arm
- Worse with overhead reaching, lifting, and reaching behind you, like putting on a coat or reaching into the back seat of a car
- Tender to press over the groove at the front of the shoulder
- Night pain, especially lying on that side
- Sometimes a snap or click at the front of the shoulder. That can mean the tendon is slipping out of its groove, which is worth mentioning to your doctor
The rotator cuff connection
- Pure biceps tendinitis is the exception. Most people with it also have rotator cuff tendinitis, a cuff tear, impingement, or a labral tear
- That changes the treatment. Settling the cuff and improving how the shoulder moves takes load off the biceps tendon too. See rotator cuff tendinitis
- Overhead athletes such as throwers, swimmers and tennis players are more likely to have a labral tear alongside it. See shoulder labral tear
- Scans find a lot. Tendon changes and cuff tears are common in people over 50 with no pain, so what’s on your report needs to match where and when it hurts
Treat the shoulder the biceps lives in, and the biceps usually settles.
What helps
- Change what flares it, don’t stop everything: less overhead lifting and reaching behind for a few weeks. Carry things close to your body
- Exercise: the backbone of treatment. Strengthen the rotator cuff and shoulder blade muscles, then build up to overhead strength over about 12 weeks. See shoulder impingement exercises, which suit most cuff-related shoulder pain
- The pain rule: mild discomfort during exercise is fine. It should settle within a few hours and be back to normal by the next morning
- Anti-inflammatory tablets: can help pain for a short spell, if they’re safe for you. Ask your pharmacist
- Ice: 15 to 20 minutes after activity can ease the ache
Injections
- A cortisone injection around the tendon sheath can calm pain enough to exercise. It’s a window, not a cure
- Ultrasound guidance matters. The tendon sheath is small, and guided injections land in the right place far more reliably than injections done by feel
- The needle goes around the tendon, not into it. Steroid injected straight into a tendon can weaken it
- Don’t rely on repeated shots. See cortisone shot side effects
The AAOS OrthoInfo guide to biceps tendinitis has a diagram of where the tendon runs.
When surgery comes up
Surgery is usually considered only after about 3 months of proper treatment hasn’t helped, and it’s often done alongside surgery for the rotator cuff or labrum. There are two main options:
- Tenodesis: the tendon is cut from its attachment inside the joint and fixed lower down on the arm bone. The painful part is out of the joint and the muscle keeps its normal shape. Often chosen for younger, active people
- Tenotomy: the tendon is simply released and left to settle. It’s quicker, with a faster recovery, but the biceps muscle is more likely to change shape. Often chosen for older or less active people
- Both usually relieve the pain well. Ask your surgeon which they recommend for you and why
Get seen today if
- Your shoulder is hot, swollen and very painful and you feel unwell or have a fever
- You have shoulder pain with chest pain, breathlessness or sweating. Call emergency services
Get it checked if
- You felt a sudden pop at the front of the shoulder, then bruising and a change in the shape of your biceps muscle. The tendon may have torn. See a doctor within a few days. It’s rarely an emergency
- Pain isn’t easing after 6 weeks of exercise and activity changes
- The front of your shoulder clicks or snaps painfully
- The arm feels weak, not just sore
- Night pain keeps waking you week after week
The pain sits in the biceps. The fix usually sits in the rest of the shoulder.