Proximal Biceps Tendonitis Causes, Symptoms & Treatment

Overview

The biceps muscle is located on the front of the upper arm and runs from the elbow to the shoulder. It has two parts, called the long head and the short head. Each part connects to the shoulder with a tendon, which is a strong band of tissue that attaches muscle to bone and helps move the joint.

The long head attaches inside the shoulder joint and is a common cause of pain in the front of the shoulder. The short head attaches to a different area of the shoulder and usually does not cause pain. When these tendons become irritated or swollen, it is called biceps tendonitis. If the irritation happens near the shoulder, it is called proximal biceps tendonitis.

What causes Proximal Biceps Tendonitis?

Proximal biceps tendonitis usually develops from repeated shoulder movements, especially activities that involve lifting the arm overhead, such as throwing. Over time, these motions put too much stress on the biceps tendon, causing it to become irritated and swollen. This condition often develops slowly and is common in people who lift frequently or play sports or work in jobs that require a lot of overhead movement.

• How the Injury Occurs: Tendon inflammation occurs when repetitive overhead or lifting motions overload the biceps tendon beyond its capacity.
• Common Everyday Causes: Frequent lifting, carrying heavy objects, or performing overhead work can also irritate the biceps tendon over time.

The same repetitive overhead motions can also lead to weakness and other shoulder injuries. As a result, biceps tendonitis often occurs alongside:

• Arthritis in the shoulder: Degeneration of the shoulder joint can increase stress on the biceps tendon.
• Rotator cuff tears: Weakness or tears in the rotator cuff make the biceps tendon work harder.
• Shoulder impingement: Compression of tendons in the shoulder can irritate the biceps tendon.
• Shoulder instability: Loose or unstable joints can strain the tendon during movement.
• Superior labrum anterior and posterior (SLAP) tears: Damage to the labrum often affects tendon function.

Biceps tendonitis is common in these sports:

• Baseball: Repeated pitching stresses the biceps tendon.
• Golf: Overhead and swinging motions place continuous strain on the tendon.
• Swimming: Repetitive arm strokes can overload the biceps tendon.
• Tennis: Frequent serves and overhead shots stress the tendon.

Symptoms

You may have proximal biceps tendonitis if you experience one or more of the following:

• Pain with overhead motions that increases during activities like lifting or throwing
• Pain radiating down the front of the upper arm

If untreated, bicep tendonitis symptoms can worsen and may lead to a torn biceps tendon, which can bunch up and form a noticeable bulge, often called a “Popeye arm” or “Popeye muscle.”

Non-operative treatment

Non-operative bicep tendonitis treatment for proximal biceps tendonitis aims to reduce inflammation in the upper biceps tendon and relieve pain. Most cases improve with these conservative measures, which may include:

• Resting the affected arm to allow the tendon to heal
• Applying ice packs intermittently throughout the day to reduce swelling
• Taking non-steroidal anti-inflammatory medications (NSAIDs), like ibuprofen, to relieve pain and inflammation
• Physical therapy to strengthen the shoulder and upper back muscles, promoting proper shoulder mechanics
• Corticosteroid injections are administered by an orthopedic specialist to decrease inflammation and alleviate bicep tendon pain

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

Proximal Biceps Tendonitis

Surgical Treatment

Surgery for biceps tendonitis is rarely needed, as most cases improve with non-operative care. However, if a tendon tear or complications occur, surgery may be necessary. Two common techniques include:

• Biceps Tenotomy: Usually performed on less active individuals or the non-dominant arm. The surgeon cuts the biceps tendon and releases it from the glenoid labrum, allowing it to hang. About 30% of cases may develop a visible bulge called a “Popeye muscle”, though shoulder function and strength are generally preserved.
• Biceps Tenodesis: Typically performed on the dominant or active arm, especially in athletes. The diseased biceps tendon is removed from the labrum and reattached to the front of the humerus, relieving pain while maintaining normal biceps function.

The choice of procedure depends on age, activity level, and the severity and complexity of the injury.