Bicipital Tendonitis

Introduction

Bicipital tendonitis is inflammation of the long head of the biceps tendon, which runs from the upper arm into the front of the shoulder (Figure 1). This tendon helps stabilize the shoulder and assists in bending and rotating the arm. Bicipital tendonitis often develops from overuse, repetitive overhead movements, or age-related wear and tear. It can cause pain in the front of the shoulder that may radiate down the arm, along with tenderness or a snapping sensation when the arm moves. It commonly occurs along with rotator cuff tendonitis, since both conditions result from similar shoulder stress or degeneration. If the tendon becomes severely weakened, it can sometimes tear completely, leading to a proximal biceps tendon rupture—a condition where the tendon detaches from the shoulder, often causing a sudden “pop” and muscle deformity.

Diagnosing Bicipital Tendonitis

A doctor diagnoses bicipital tendonitis through a combination of medical history, physical examination, and imaging studies. During the exam, the doctor may press over the bicipital groove (the front part of the upper arm bone) to check for tenderness. Specific tests such as the Speed’s test (resisted arm raising) or Yergason’s test (resisted forearm rotation) can reproduce pain in the biceps tendon area, helping confirm the diagnosis. Imaging studies may include ultrasound or MRI to visualize inflammation, thickening, or partial tearing of the tendon. These scans can also help determine whether rotator cuff tendonitis or a partial biceps tear is present, which often influence treatment decisions.

Conservative Treatment of Bicipital Tendonitis

Most cases of bicipital tendonitis improve with conservative treatment. The main goals are to reduce inflammation, relieve pain, and allow the tendon to heal. Resting the shoulder and avoiding overhead activities are important early steps. Ice and anti-inflammatory medications can help ease discomfort. Once pain decreases, physical therapy focuses on stretching and strengthening the shoulder and upper-back muscles to improve posture and reduce strain on the tendon. Some patients benefit from corticosteroid injections into the bicipital groove to reduce inflammation, though these are used carefully to avoid weakening the tendon. With consistent therapy, most patients regain full shoulder motion and function.

Surgical Treatment of Bicipital Tendonitis

Surgery is considered if symptoms persist for several months despite non-surgical care, or if imaging shows a significant tendon tear. The most common operations are biceps tenotomy and biceps tenodesis. In a tenotomy, the damaged tendon is simply released from its attachment, relieving pain but sometimes causing a slight “Popeye” bulge in the upper arm. In a tenodesis, the tendon is detached from the shoulder and reattached to the humerus (upper arm bone), which preserves the shape and strength of the arm. These procedures are typically performed arthroscopically, using small incisions and a camera. If rotator cuff problems are also present, they are often repaired at the same time.

Prognosis

The prognosis for bicipital tendonitis is generally excellent. With early recognition and proper treatment, most people recover fully and return to their usual activities without lasting problems. Physical therapy and activity modification are key to preventing recurrence. However, if the condition is ignored or continues to worsen, the tendon can degenerate and may eventually rupture, leading to pain, weakness, and cosmetic changes in the arm. Fortunately, even in cases of rupture, many patients regain good function with therapy or minor surgery.

Summary

Bicipital tendonitis is shoulder pain caused by inflammation of the biceps tendon. It often happens with rotator cuff tendonitis from overuse or aging. Doctors diagnose it with exam tests and scans like MRI or ultrasound. Most people get better with rest, therapy, and medicine, but surgery may be needed if pain continues or the tendon tears. With proper care, recovery is usually very good, but ignoring it can lead to a biceps tendon rupture.

Edited by Stephen Pinney MD, October 9th 2025.