Bicep Tendonitis: Causes, Symptoms, and Treatment Options

What Is Bicep Tendonitis?

Biceps tendonitis is a painful inflammatory condition affecting the tendon that connects the biceps muscle to the shoulder joint. The biceps muscle has two tendons at the shoulder: the long head and the short head. The inflammation most commonly occurs in the long head tendon as it passes through the shoulder joint. Repetitive arm movements, overuse, or gradual wear and tear can irritate this tendon, leading to shoulder pain and restricted movement.

Biceps tendonitis often develops alongside other shoulder problems, such as rotator cuff injuries or arthritis, making early diagnosis and proper treatment essential for preventing long-term complications.

Anatomy of the Biceps Tendons

The biceps brachii muscle runs along the front of the upper arm and plays a key role in elbow flexion and forearm rotation. It attaches to the shoulder via two tendons. The long head tendon travels through a groove in the upper arm bone (humerus) and attaches inside the shoulder joint, while the short head tendon attaches to the shoulder blade.

Because the long head tendon passes through the shoulder joint and experiences repeated friction during overhead movements, it is particularly vulnerable to inflammation and degeneration.

Types of Bicep Tendonitis

Bicep tendonitis can be classified into several distinct types based on location and underlying causes:

• Primary biceps tendonitis: Inflammation limited to the biceps tendon without other associated shoulder injuries
• Secondary biceps tendonitis: Occurs together with rotator cuff tears, shoulder impingement, or shoulder arthritis
• Acute bicep tendonitis: Sudden onset due to injury or excessive strain
• Chronic bicep tendonitis: Develops gradually from repetitive use or age-related tendon degeneration

Causes of Bicep Tendonitis

Several factors can contribute to the development of bicep tendonitis, with overuse being the most common cause:

• Repetitive overhead motions: Sports like swimming, baseball, tennis, volleyball, and weightlifting place significant stress on the biceps tendon through repetitive overhead movements.

• Age-related degeneration: As people age, tendons naturally weaken and lose flexibility, making them more susceptible to injury and inflammation.

• Sudden forceful loads: Lifting heavy objects or experiencing trauma that exceeds the tendon’s capacity can cause immediate damage and subsequent inflammation.

• Mechanical impingement: Bone spurs, abnormal shoulder blade shape, or thickened ligaments can create friction against the biceps tendon during movement.

• Poor conditioning: Returning to intense activity without proper preparation or failing to increase activity levels gradually can overwhelm the tendon's capacity to adapt.

Risk Factors for Bicep Tendonitis

Certain individuals are more likely to develop bicep tendonitis due to various risk factors:

• Athletic participation: Overhead sports such as swimming, baseball, tennis, volleyball, and pickleball significantly increase your risk of developing this condition.

• Occupational hazards: Jobs requiring repetitive shoulder motions, overhead reaching, or heavy lifting can predispose you to bicep tendonitis.

• Age-related changes: People over 40 are at higher risk due to natural tendon weakening and decreased tissue elasticity that occur with aging.

• Previous shoulder injuries: A history of rotator cuff tears, shoulder impingement, or other shoulder problems increases your likelihood of developing secondary bicep tendonitis.

• Sudden activity increases: Rapidly returning to intense weightlifting or sports without proper conditioning can overwhelm your tendons' ability to adapt safely.

Symptoms of Bicep Tendonitis

Recognising biceps tendonitis symptoms early can help you seek appropriate treatment and prevent progression to more serious complications:

• Anterior shoulder pain: The most common symptom is pain in the front of your shoulder or upper arm that worsens with overhead activities or lifting.

• Bicipital groove tenderness: Localised tenderness may occur over the front of the shoulder where the tendon lies when pressing on the biceps tendon in the front of your shoulder.

• Activity-related discomfort: Pain typically increases with lifting, reaching overhead, or performing repetitive arm movements.

• Weakness and fatigue: Your arm may feel weak or tire easily during lifting or pulling activities.

• Clicking or snapping: Some people experience unusual sounds or sensations in their shoulder during movement.

• Night pain: In more advanced cases, pain may disturb sleep or occur even at rest.

Early vs Advanced Symptoms

Bicep Tendonitis vs Rotator Cuff Injury

Bicep Tendonitis vs Bicep Tendon Tear

How is Bicep Tendonitis Diagnosed?

Healthcare providers use several approaches to accurately diagnose bicep tendonitis:

• Detailed medical history and symptom review
• Physical examination of shoulder movement and strength
• Assessment for associated conditions like arthritis or rotator cuff injuries

Physical Tests for Bicep Tendonitis

Several specific physical tests help confirm a bicep tendonitis diagnosis:

• Speed’s test to assess pain during resisted arm flexion
• Yergason’s test to assess biceps tendon stability and possible subluxation
• Palpation for tenderness along the biceps groove

Imaging Tests Used

If the physical exam points to bicep tendonitis, imaging helps confirm inflammation and rule out related shoulder injuries.

• Ultrasound can quickly show tendon thickening, tenosynovitis, or fluid around the tendon and may detect instability during movement.
• An MRI scan is used when doctors need a clearer view of the tendon and associated problems, such as rotator cuff tears, while X-rays help rule out arthritis or other bone-related causes of pain.

According to StatPearls (NCBI Bookshelf), proximal biceps tendinitis or tendinopathy most often affects the long head of the biceps tendon in the bicipital groove, typically causing anterior shoulder pain that worsens with overhead activity. It also highlights frequent overlap with rotator cuff pathology/impingement, and that diagnosis commonly combines provocative tests (Speed’s, Yergason’s/Uppercut) with ultrasound and MRI for confirmation and assessment of associated injuries.

Treatment for Bicep Tendonitis

Effective bicep tendonitis treatment typically begins with conservative approaches:

• Rest and modification of activities that aggravate symptoms
• Ice application to reduce inflammation
• Physical therapy to improve strength, flexibility, and shoulder stability
• Posture correction and ergonomic adjustments

Medications for Pain and Inflammation

Several medication options can help manage biceps tendon pain and inflammation:

• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Pain relievers as prescribed
• Corticosteroid injections may be used in severe cases under medical supervision

Surgery for Bicep Tendonitis

Surgery is rarely necessary and reserved for cases in which conservative treatment has not been successful. Surgical options may include tendon release or tendon repair, often performed alongside therapy for rotator cuff injuries. A specialist determines the need for bicep tendonitis surgery based on imaging findings and symptom severity.

Recovery Time for Bicep Tendonitis

Mild cases often resolve within a few weeks with rest and physical therapy, while chronic or severe cases can take several months for full recovery. Early diagnosis significantly shortens healing time and reduces the risk of recurrence.

Complications if Left Untreated

Ignoring bicep tendonitis can lead to several serious complications:

• Tendon degeneration: Chronic inflammation can progress to tendinosis, in which the tendon tissue becomes degenerated, damaged, and weakened.

• Complete tendon rupture: Untreated tendonitis may eventually lead to full tendon tears, resulting in the characteristic "Popeye" muscle deformity.

• Chronic pain syndrome: Persistent inflammation can cause long-term pain that becomes increasingly difficult to treat effectively.

• Secondary shoulder problems: Compensatory movement patterns can lead to rotator cuff damage or worsening impingement syndrome.

Prevention of Bicep Tendonitis

Taking proactive steps can help prevent bicep tendonitis development:

• Proper warm-up routines: Always perform adequate stretching and warm-up exercises before engaging in overhead activities or sports.

• Gradual activity progression: Slowly increase exercise intensity and duration to allow your tendons time to adapt and strengthen.

• Shoulder stabilization exercises: Regular strengthening of rotator cuff muscles and scapular stabilisers provides better support for the biceps tendon.

• Technique optimisation: Work with qualified coaches or trainers to ensure proper form during sports activities and weightlifting.

• Regular rest periods: Schedule adequate recovery time between intense training sessions to prevent overuse injuries.

When to See a Doctor?

Seek medical attention if you experience any of these warning signs:

• Persistent pain: Shoulder pain lasting more than two weeks despite rest and home care..

• Inflammatory signs: Swelling, redness, or warmth in the front of your shoulder that doesn't improve.

• Functional limitations: Inability to lift your arm overhead or perform routine daily activities without significant pain.

• Sleep disturbance: Night pain that disrupts rest, or clicking and snapping sensations in your shoulder during movement.

• Acute injury: Pain following a sudden injury, fall, or trauma that doesn't resolve within a few days.

Conclusion

Bicep tendonitis is a common but treatable cause of shoulder pain when diagnosed early and managed correctly. Accurate diagnosis through physical examination and imaging is crucial for preventing long-term complications such as tendon tears or chronic shoulder dysfunction.

With access to 4,000+ diagnostic tests, advanced imaging such as MRI, full-body health checkups, and trusted home sample collection across 10,000+ touchpoints, Metropolis Healthcare ensures quick, accurate diagnoses and timely intervention. Easy booking via website, app, call, or WhatsApp makes expert care accessible, helping you recover faster and move comfortably and pain-free with confidence.

FAQs

What causes bicep tendonitis?

Bicep tendonitis is caused by repetitive strain, overuse, ageing-related degeneration, poor posture, or shoulder instability.

How long does bicep tendonitis take to heal?

Most cases heal within 4–12 weeks, depending on severity and treatment adherence.

Is bicep tendonitis serious?

It is usually manageable, but untreated cases can progress to chronic pain or tendon rupture.

Can bicep tendonitis heal on its own?

Mild cases may improve with rest, but medical evaluation ensures proper recovery.

What exercises should be avoided with bicep tendonitis?

Overhead lifting, heavy weightlifting, and repetitive arm movements should be avoided during recovery.

Is bicep tendonitis the same as a torn biceps?

No. Tendonitis is inflammation, while a tear involves partial or complete tendon rupture.

Can weightlifting cause bicep tendonitis?

Yes, especially with improper technique or excessive load.

Does bicep tendonitis require surgery?

Surgery is rarely needed and is reserved for severe or persistent cases.

How do you know if bicep tendonitis is getting worse?

Increasing pain, weakness, or reduced movement may indicate worsening.

Can bicep tendonitis come back?

Yes, especially if underlying risk factors are not addressed.

References
1.    https://www.ncbi.nlm.nih.gov/books/NBK533002/
2.    https://my.clevelandclinic.org/health/diseases/bicep-tendonitis
3.    https://orthoinfo.aaos.org/en/diseases--conditions/biceps-tendinitis/
4.    https://emedicine.medscape.com/article/96521-overview