The biceps muscle at the front of the upper arm, used to raise the arm and bend the elbow, is attached to both the shoulder and the elbow by means of tendons, tough cords of a connective tissue called collagen. Tendons pull on bones when muscles are contracted, causing movement of the bone. If the tendon is injured it can cause pain or inflammation. This condition is called biceps tendonitis, although it may also be known as tendinopathy if there is pain but no inflammation.
The proximal (nearest the trunk of the body) end of the biceps muscle has two tendons, one that attaches the muscle to the upper side of the shoulder socket, and another that attaches to a bony protuberance on the shoulder blade called the coracoid process.
At the distal (furthest from the trunk of the body) end of the biceps, the biceps tendon attaches to the radius, one of the two bones in the forearm.
The proximal biceps tendons are more likely to be injured than the distal tendon.
Biceps tendonitis occurs when some or all of the fibers that make up the tendon become frayed or broken. This leads to pain, weakness, and impaired function of the biceps muscle. Tendon strands can heal themselves with time, but if the muscle is not rested the tendon fiber cells do not have time to regenerate and tendonitis can develop.
The two main causes of biceps tendonitis are overuse and injury. The natural aging process weakens tendons and makes them more vulnerable to injury, as does smoking or taking corticosteroid medication. If your occupation requires much lifting or raising your arms above your head you may also be at increased risk of developing tendonitis. Athletes such as swimmers or tennis players may damage their biceps tendons due to repetitive and excessive overhead motions.
Traumatic tearing of the tendons may happen during a fall or lifting too heavy a weight, or it may be a symptom of another underlying problem such as a rotator cuff injury or a torn ligament that usually holds the tendon in position.
- Sharp pain at the moment of injury
- Possible ‘popping’ sound at the moment of injury
- Aching pain as the tendonitis gradually worsens
- Pain may become worse at night, and with certain movements
- Tenderness to touch at the site of injury
- Muscle weakness in the shoulder or elbow
- Decreased ability to turn the palm up or down
- Possible bruising in the upper arm
- Possible bulge in the arm above the elbow if the tendon is completely ruptured, known as a ‘Popeye Muscle’
Your doctor will ask you about your medical history, including any previous injuries to your shoulder or arm. Your general lifestyle, activities, and participation in sport will be discussed. You will be asked about the circumstances of your current injury and the onset, duration, and severity of your symptoms.
Your shoulder and arm will be physically examined. A complete tendon rupture is often easily diagnosed, as the arm will exhibit the characteristic ‘Popeye Muscle’ bulge. You may be asked to move your arm in certain ways as pain caused by such movements can indicate a partial tendon tear.
X-rays may be taken because although they do not show tendons, they can reveal other conditions that may be causing your symptoms. Ultrasound can assist with diagnosis. It is possible that you will have an MRI (magnetic resonance imaging) scan as these create clear images of soft tissues such as tendons, and will show any damage.
If treatment has not alleviated your symptoms, a surgical technique called arthroscopy may be used to assess your condition. In such cases any surgical repair necessary might be performed at the same time.
Most biceps tendon tears will recover in time, without surgery. In rare cases conventional treatment will not relieve symptoms, and for some people such as athletes or those whose occupations require repeated lifting or overhead movements, surgery may be necessary.
Conservative (non-surgical) treatment of biceps tendonitis consists of:
Avoid any activities that make your symptoms worse, particularly raising your arm overhead or lifting heavy objects. You may want to wear a sling temporarily to support your arm.
Applying ice, crushed in a bag and wrapped in a towel, to the damaged area for as long as is comfortable, several times a day, will help to reduce swelling and inflammation.
Non-steroidal anti-inflammatory drugs such as ibuprofen (Advil), naproxen (Aleve) or aspirin can be taken to relieve pain and inflammation.
After the acute stage of the injury you can begin a graduated program of exercises to restore flexibility and improve strength in your arm.
If surgery is considered necessary, the best procedure for your particular injury would be discussed with you. Surgical repair of a partially or completely torn tendon is performed arthroscopically whenever possible, using narrow instruments inserted through small incisions around the site of damage. This is a minimally invasive technique and results in a shorter recovery time than conventional surgery. Surgically reattaching a biceps tendon is usually a very successful operation. You would need to gradually rehabilitate your arm using exercises and other techniques, as recommended by your physical therapist.
When doing these exercises you should feel nothing more than a very mild pain. If you feel a sharp pain you must stop immediately. It is helpful to warm the shoulder before beginning by either taking a shower or using a heat pack.
Standing or sitting, let your arm hang down at your side. Allow your arm to swing from side to side and back and forth, then in small circles. Keep the distances short. Repeat this exercise for 3-7 days then add a small weight (1-2 lbs). Gradually increase the range of motion.
Standing and facing a wall that is about three-quarters of your arm’s length away, walk your fingers up the wall. Do not use your shoulder muscles to achieve this - just your fingers. You should be able to gradually increase the height that your fingers reach.