Biceps Tendon Pain

Biceps tendinopathy is irritation and gradual breakdown of one of the biceps tendons in your shoulder. The long head of the biceps starts at the top of the shoulder socket, right at the labrum, and runs through a groove in the upper arm bone. Each time you reach overhead, that tendon is pulled hard through the groove; over months and years, the friction wears it down. It is most common in middle-aged adults and athletes who throw or lift overhead, and it often shows up alongside a rotator cuff problem or shoulder impingement (a pinching of those tendons under the bony arch of the shoulder).

The pain sits at the front of your shoulder, right where you can feel the tendon in its groove if you press with a fingertip, and gets worse when you reach overhead, lift something in front of you, or twist your forearm palm-up (supination). The pain may radiate down the front of your upper arm, following the path of the tendon. Some patients notice a clicking or snapping sensation as the tendon slides in and out of its groove, especially during rotation.

Because biceps tendinopathy almost always coexists with a rotator cuff problem or shoulder impingement, the symptoms can overlap, shoulder pain at night, weakness with overhead tasks, and a general sense that the shoulder is not performing the way it used to. Your provider sorts out which structure is contributing most during the exam.

Your provider will do a focused physical exam of the shoulder. Pain reproduced right over the tendon in its groove points to the biceps tendon as the source.

Ultrasound is the most useful first imaging study: it shows tendon swelling, fluid around the tendon in the groove, and partial tears, all in real time, often done in the office at the same visit. MRI is reserved for cases where your provider also suspects a shoulder labral tear (SLAP) (a tear of the cartilage where the tendon anchors at the top of the socket) or a rotator cuff problem alongside it.

Care starts with the simplest measures and adds to them step by step, each one stacked on top of the last rather than replacing it. The goal at every stage is the same: take load off the tendon while it heals. Surgery comes up only if these steps are not enough.

1. Bicipital groove injection

   An injection of corticosteroid placed next to the tendon in its groove, guided in real time by ultrasound, useful when the inflammation is acute and the earlier steps have not been enough.

Surgery is considered when the tendon has degenerated significantly and is not responding to non-operative care, or when a rotator cuff repair is being planned anyway. Two options: tenotomy (releasing the tendon from its origin so it retracts out of the painful groove) or tenodesis (releasing it and re-attaching it lower down, which preserves the muscle's strength and contour).

External patient-education references and related OSI pages for additional background:

• AAOS OrthoInfo, patient education library
• OSI glossary, orthopedic terminology in plain language