Proximal Biceps Tendonitis Causes, Symptoms & Treatment

The biceps muscle is located in the front of the upper arm and goes from the elbow to the shoulder. The biceps muscle is composed of two muscles, the long head and the short head. Each head of the biceps muscle has a tendon that attaches the muscle to the shoulder. The long head attaches to the glenoid and is a common cause of shoulder front pain. The short head attaches to a point on the scapula, called the coracoid process, and typically does not cause shoulder pain. When the tendons that connect the biceps muscle to the bone become inflamed, this is referred to as biceps tendonitis. More specifically, this is known as proximal biceps tendonitis since the inflammation occurs near the shoulder.

Biceps tendonitis generally develops with repetitive motions of the shoulder, most often overhead motions, such as throwing a baseball. Over a long period of time, repetitive overhead motions can place excessive stress on the biceps tendon. Overworked and overused biceps tendons can become irritated and inflamed. This upper biceps tendon inflammation often develops gradually, particularly in individuals with lifting-related pain or those involved in sports and occupations that require frequent overhead activity.

Additionally, the same overhead motions that cause inflammation in the biceps tendons are also the cause of weakness and numerous injuries to the structure of the shoulder and rotator cuff. For this reason, biceps tendonitis is commonly seen in conjunction with other conditions, such as:

• Arthritis in the shoulder
• Rotator cuff tears
• Shoulder impingement
• Shoulder instability
• Superior labrum anterior and posterior (SLAP) tears of the shoulder

Biceps tendonitis is common in these sports:

• Baseball
  
• Golf
  
• Swimming
  
• Tennis

If you experience one or more of the following symptoms, you may have proximal biceps tendonitis:

• Pain with overhead motions
• Pain that radiates down the anterior (front) upper arm

If left untreated, symptoms of biceps tendonitis can worsen and can lead to tearing of the affected tendon. A torn biceps tendon can ball up and form a bulge, a condition often referred to as “Popeye arm” or “Popeye muscle.”

If you have symptoms of proximal biceps tendonitis that are interfering with your ability to play at your best capacity, make an appointment with an orthopedic specialist. If you have pain in the front of your shoulder that does not subside with non-surgical treatments or that gets worse, make an appointment to see an orthopedic specialist right away — you may have a more serious injury to the biceps tendon, such as a tear.

During your appointment with your doctor, your doctor will examine your shoulder to assess your range of motion and strength. In order to make a diagnosis, your doctor may prescribe the following imaging tests:

• X-ray
• MRI

The goal of non-operative treatment for proximal biceps tendonitis is to reduce upper biceps tendon inflammation and, therefore, eliminate pain. If you’re experiencing symptoms of biceps tendonitis, non-operative treatments will usually resolve the condition. Non-operative treatments may include:

Resting the affected arm

• Applying ice packs to the affected area intermittently throughout the day
  
• Taking non-steroidal pain and anti-inflammatory medication, like Ibuprofen, to reduce swelling and relieve pain
  
• Physical therapy to strengthen the muscles of the upper back and the shoulder in order to ensure proper shoulder mechanics
  
• Corticosteroid injections to reduce swelling and relieve pain (administered to you by an orthopedic specialist)

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

Proximal Biceps Tendonitis

Biceps tendonitis rarely needs surgery, as non-operative treatments will typically relieve symptoms. However, if surgery is needed to treat biceps tendonitis, or if complications from biceps tendonitis occur — such as a tear in the bicep tendon — surgical treatment can be performed using one of two techniques:

• Biceps tenotomy: Biceps tenotomy is typically performed in less active individuals or in the non-dominant arm. During a biceps tenotomy, the surgeon will cut the bicep tendon and release it from the glenoid labrum, letting it hang. The remaining biceps tendon connection will support the biceps muscles. Approximately 30 percent of the time, this may cause a deformity called a “popeye muscle.” Usually the function of the shoulder is fine with minimal loss of strength.
• Biceps tenodesis: Biceps tenodesis is performed on the active or dominant arm for athletes. During this surgery, the orthopedic surgeon removes the diseased bicep tendon that attaches to the glenoid labrum and re-attaches it to the front of the humerus. Removing the diseased bicep tendon from the labrum eliminates pain and maintains the normal function of the bicep.

The type of surgery recommended to you by your doctor will depend on your age, activity level and, the severity and complexity of your injury.

Your recovery time will depend on the severity of the proximal biceps tendonitis as well as your treatment requirements. If non-operative treatments are successful, recovery time will usually be less than 6 weeks.

If surgery is needed, your recovery time will depend on the procedure performed. Biceps tenotomy is associated with a shorter recovery compared to a biceps tenodesis procedure — recovery time may be as short as 3 months. Biceps tenodesis requires a longer recovery time, generally six to 12 months.

You should only return to sports when you are pain-free and have recovered a full range of motion and strength.