Bicep Tendonitis: Symptoms, Types, Causes and Treatment

Bicep tendonitis is a common condition that affects athletes and non-athletes alike, causing pain and discomfort in the upper arm and shoulder. Understanding its symptoms, types, causes, and treatments is crucial for effective management and rapid recovery. This comprehensive guide explores current research to provide you with a clear, evidence-based overview of bicep tendonitis.

Symptoms of Bicep Tendonitis

Bicep tendonitis doesn’t just cause arm pain—it can disrupt daily activities and athletic performance. Early recognition of symptoms is key in seeking timely intervention and preventing further injury. Here, we summarize the key signs you should be aware of.

Symptom	Description	Location	Source(s)
Ache	Deep, throbbing pain	Anterior shoulder	1 2
Point Tenderness	Pain when pressing on the bicipital groove	Upper arm/shoulder	1
Exacerbation	Worsens with overhead or repetitive motion	Shoulder/elbow	1 2 4
Relief	Eases with rest and pain medication	General	2

Table 1: Key Symptoms

Deep-Dive into Symptoms

Deep, Throbbing Ache

A hallmark of bicep tendonitis is a persistent, deep ache in the front (anterior) part of the shoulder. This discomfort is often described as throbbing and may intensify after activity, especially movements involving the arms raised overhead or repetitive lifting 1 2.

Point Tenderness

Pressing on the area where the biceps tendon runs through the bicipital groove of the upper arm elicits pain or tenderness. This is a classic finding during a physical exam and helps distinguish bicep tendonitis from other shoulder problems 1.

Activity-Related Pain

Pain tends to worsen with specific actions—most notably, lifting, throwing, or any activity involving repetitive use of the shoulder or elbow. Athletes, particularly those in sports like baseball, tennis, or swimming, often notice pain during or after overhead motions 1 2 4.

Relief with Rest

One of the more reassuring signs for patients is the reduction in pain with rest or the use of oral analgesics. However, relief is usually temporary, and symptoms can quickly return once activity resumes 2.

Types of Bicep Tendonitis

Bicep tendonitis is not a single, uniform condition. Understanding its various forms can help tailor the approach to diagnosis and management. Below is a summary of the main types and related entities.

Type	Description	Typical Patient	Source(s)
Primary	Inflammation in the bicipital groove (isolated)	5% of cases	1 6 9
Secondary	Due to other shoulder pathologies (e.g. impingement)	Most cases	1 4 9
Tendonitis	Inflammation of the tendon	Younger, active	1 2
Tendinosis	Degenerative changes, little actual inflammation	Older/adult athletes	1 9

Table 2: Types of Bicep Tendonitis

Exploring the Types

Primary Bicep Tendonitis

This rare form accounts for about 5% of cases and involves direct inflammation of the biceps tendon in the bicipital groove, without any other associated shoulder pathology. It is often confirmed via imaging studies or diagnostic injections 1 6.

Secondary Bicep Tendonitis

Secondary tendonitis is far more common and usually occurs alongside other shoulder issues, such as rotator cuff tears, shoulder impingement, or SLAP (superior labrum anterior to posterior) lesions. These underlying conditions often drive the inflammation or degeneration of the biceps tendon 1 4 9.

Tendonitis vs. Tendinosis

While "tendonitis" implies inflammation, research shows that many chronic cases are actually "tendinosis," marked by degenerative changes without significant inflammation. Tendonitis is more likely in acute injuries or younger individuals, while tendinosis is common in older adults or those with long-term overuse 1 2 9.

Related Pathologies

• Partial tearing: The tendon may be partially torn, causing pain and dysfunction.
• Subluxation: The tendon can slip out of its normal groove, often due to concurrent injuries (e.g., to the subscapularis tendon) 3.
• Distal Biceps Tendonitis: Although most cases involve the shoulder, the distal tendon near the elbow can also become inflamed, particularly in weightlifters or manual laborers 8.

Causes of Bicep Tendonitis

Bicep tendonitis is multifactorial. Recognizing the underlying causes can help with both prevention and targeted treatment. Here's a summary of the top factors.

Cause	Description	Who’s at Risk	Source(s)
Overuse	Repetitive overhead or strenuous motion	Athletes, laborers	1 3 4
Impingement	Tendon pinched beneath coracoacromial arch	Older adults, athletes	1 4 9
Degeneration	Age-related wear and tear	Middle-aged, elderly	1 9
Instability	Tendon subluxation/dislocation	Those with rotator cuff tears	3 4 9
Rare: Tumor	Osteochondroma in bicipital groove	Rare, case reports	4

Table 3: Major Causes

Breaking Down the Causes

Overuse and Repetitive Motion

Most cases of bicep tendonitis stem from repetitive overhead activities—think throwing, swimming, or frequent lifting. Microtrauma from these motions gradually damages the tendon, leading to inflammation or degeneration 1 3 4.

Impingement Syndrome

The biceps tendon can get pinched under the coracoacromial arch or within the shoulder joint, especially when other structures (like the rotator cuff) are weakened or injured. This causes friction, irritation, and ultimately tendonitis or tendinosis 1 4 9.

Age-Related Degeneration

As we age, tendons lose their elasticity and capacity for repair. This makes the biceps tendon more susceptible to small tears or chronic degeneration, even with normal activities 1 9.

Instability and Subluxation

If the structures that stabilize the biceps tendon (such as the subscapularis tendon or ligaments) are damaged, the biceps tendon may slide out of its groove—a condition called subluxation. This abnormal movement irritates the tendon and accelerates injury 3 4 9.

Rare Causes

Occasionally, biceps tendonitis can be triggered by unusual factors such as bone tumors (e.g., osteochondromas) compressing the tendon within its groove—a rare but documented phenomenon 4.

Treatment of Bicep Tendonitis

Treating bicep tendonitis is a stepwise process, starting with conservative measures and escalating to interventions only when necessary. Below, we lay out the main treatment options.

Treatment	Description	Indication	Source(s)
Rest & Ice	Activity modification, cold therapy	First-line	1 2
Analgesics	NSAIDs, oral pain relief	Symptom control	1 2
Physical Therapy	Exercises, stretches, strength rehab	Functional recovery	1 3
Corticosteroid Injection	Injection into tendon sheath	Persistent symptoms	1
Platelet-Rich Plasma (PRP)	Injection of growth factors	Refractory distal cases	8
Surgery (Tenotomy/Tenodesis)	Tendon release or reattachment	Failed conservative care	3 5 6 7

Table 4: Treatment Options

Understanding Treatment Strategies

Conservative Management

The vast majority of cases improve with non-surgical management. This includes:

• Rest and Ice: Reducing or modifying activities that provoke pain, combined with regular icing, can help minimize inflammation 1 2.
• Analgesics: Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen are often recommended to control pain 1 2.
• Physical Therapy: Targeted exercises and stretches restore strength, flexibility, and range of motion. Therapists may also address underlying biomechanical issues that contribute to tendonitis 1 3.
• Corticosteroid Injections: If symptoms persist, a corticosteroid injection into the tendon sheath can provide significant relief. These injections can be both diagnostic (confirming the source of pain) and therapeutic 1.

Advanced/Adjunct Treatments

• Platelet-Rich Plasma (PRP): For chronic or refractory cases of distal biceps tendonitis, PRP injections have shown promising results in improving pain and function, though more research is needed 8.

Surgical Options

Surgery is reserved for cases where conservative management fails after several months, or if there is significant structural damage to the tendon:

• Tenotomy: The tendon is released from its attachment, providing pain relief but sometimes resulting in a cosmetic “Popeye” deformity (bulge in the arm) 5 7.
• Tenodesis: The tendon is detached and then reattached to the humerus. This procedure preserves muscle contour and function, with a lower risk of deformity compared to tenotomy 3 6 7.
• Arthroscopic Approaches: Modern techniques use minimally invasive arthroscopy for both diagnosis and treatment, improving outcomes and reducing recovery time 5 7.
• Individualized Approach: The choice between tenotomy and tenodesis depends on age, activity level, cosmetic concerns, and associated shoulder pathology. Both procedures yield good pain relief and function, but tenodesis is preferred in younger or more active individuals due to a lower risk of deformity 3 6 7 9.

Conclusion

Bicep tendonitis is a multifaceted condition that can significantly impact quality of life if left unaddressed. Timely recognition of symptoms, understanding the underlying cause, and following a stepwise treatment plan are crucial for optimal recovery.

Key Points:

• Bicep tendonitis typically presents with a deep, throbbing ache in the front of the shoulder, worsened by movement and relieved by rest 1 2.
• There are several types, including primary, secondary, tendonitis, and tendinosis, each with distinct characteristics and implications for treatment 1 6 9.
• Common causes include overuse, impingement, degeneration, and instability; rare cases may result from tumors 1 3 4 9.
• Most patients recover with conservative management (rest, physical therapy, NSAIDs), while surgery (tenotomy or tenodesis) is reserved for persistent or severe cases. PRP injections may help in refractory distal tendonitis 1 3 5 6 7 8.
• An individualized approach is vital, considering patient age, activity level, and cosmetic concerns 3 7 9.

By staying informed and proactive, individuals experiencing bicep tendonitis can expect a positive outcome and a return to their favorite activities.