Biceps Tendinopathy

1. What is biceps tendinopathy


Biceps tendinopathy is a pathology of the proximal biceps tendon, that is, where the biceps tendon crosses over the head of the humerus or top of the arm bone.




2. How does it present?

This issue usually presents as pain at the front of the shoulder. The pain may also extend further towards the elbow.   This may be worse with elevation of the shoulder, reaching, and/or bending of the elbow.   Often, patients will describe feeling tired or heavy in the shoulder with repeated activities.  Symptoms may feel better with ice and rest.

3. Why does it happen?

Biceps tendinopathy is generally an overuse injury. Common activities that may cause irritation of the tendon include repeated overhead activities, repetitive lifting, or prolonged reaching such as use of a computer mouse.

Commonly, this condition coexists with other shoulder pathologies. It can also be seen with rotator cuff tears of tendinopathies, bursitis, impingement syndromes, arthritis, shoulder instability, labral pathologies, or dysfunction of the stabilising muscles of the shoulder.

These pathologies mean that the shoulder is functioning and moving sub-optimally. In the case of weakness, pain, or dysfunction in other regions of the shoulder, a greater reliance can be placed on the biceps muscle and tendon to move and stabilise the shoulder.  This can place undue stress on the tendon and contribute to the onset of the tendinopathy.   These coexisting pathologies can also mean that the shoulder sits further forward than it would normally; in this case, there is more friction between the humerus and the tendon causing irritation.

4. Anatomy of biceps tendinopathy

There are two heads of the biceps brachii; the long head and the short head. The short head attaches to the coracoid process which is a prominence at the front of the shoulder blade.  The long head of the attaches to the front of the glenoid which is the socket of the ball and socket joint.  The biceps tendon sits in the bicipital groove which is a channel at the front of the shoulder.



5. How do we differentiate from other diagnosis?

A clinical examination including assessment of range of motion, strength and other special tests will help to determine the diagnosis and differentiate from other pathologies. As discussed, this condition is often present with other shoulder pathologies.  Positive findings may include pain with palpation of the long head of biceps tendon as well as positive special tests that reproduce pain with resistance of the biceps.

6. Medical imaging options

An ultrasound or MRI can confirm the diagnosis. An ultrasound is often sufficient to show whether there is some abnormality in the biceps tendon.  An MRI, however, will show pathology in the biceps tendon as well as give a clearer picture of other coexisting pathologies in the shoulder.

An x-ray may also be included in the medical imaging options to show whether there is any bony abnormalities or arthritis in the shoulder.

7. How is it treated?

In the early stages, use of simple measures such as rest and ice can help to minimise pain and inflammation. As this is commonly considered an overuse injury, it is best to avoid aggravating activities to allow symptoms to settle.

Exercises to correct strength deficits and sub-optimal biomechanics will help to address the underlying cause of the injury. Particular focus is placed on making sure that the scapula and humerus are moving in a manner that minimises stress on the tendon.  Progressive resistance and control exercises are incorporated into the routine with a view to progressing to work and sport specific exercises.

If concurrent pathologies are present, then these will also need to be addressed appropriately.


8. References


Ahrens, P. H. & Boileau, P. (2007). The long head of biceps and associated tendinopathy. The Journal of Bone and Joint Surgery (Br), 89B(8), 1001-1009


Brukner, P., & Khan, K. (2012). Clinical Sports Medicine (4th Ed.).  North Ryde, NSW: McGraw Hill