What is Biceps Tendonitis? How to Diagnose and Treat.

What is Biceps Tendonitis (Tendinitis/Tendinopathy)?

Biceps tendonitis / tendinitis / tendinopathy describes pain and tenderness in the region of the biceps tendon.

Your biceps musculotendinous junction is particularly susceptible to overuse injuries, especially in individuals performing repetitive lifting activities. This condition is often diagnosed incorrectly and confused with rotator cuff disease.
Biceps tendonitis is rarely seen in isolation. It coexists with other pathologies of the shoulder, including rotator cuff tendinopathy and tears, shoulder instability, and imbalances of the rotator cuff.

Historically, all disorders of the biceps tendon have been termed biceps tendonitis. Recent evidence suggests that degenerative changes in the tendon occur without inflammation. In acute cases, an inflammatory pathology may still be a valid explanation of biceps tendon pain.

Tendonitis describes inflammation of the tendon and the paratendon. This is usually caused by chronic overload, leading to microscopic tears in the tendon, which triggers an inflammatory response.

Peritendonitis is the inflammation of the paratendon or tendon sheath. This usually occurs as a result of a direct injury or irritation in which the tendon rubs over a bony prominence; this is referred to as a tenosynovitis.

Tendinosis is degenerative changes in the tendon.

Anatomy of the Biceps Tendon

The anatomy of the biceps brachii muscle is important in understanding biceps tendinopathy. The biceps brachii has 2 heads.

The short head arises from the tip of the coracoid process of the scapula. The long head arises from the supraglenoid tubercle of the scapula and the superior labrum runs through the intertubercular groove between the greater and lesser tubercles of the humerus.

Proximally, the long head of the biceps acts as a shoulder stabilizer through depression of the humeral head (Kumar, 1989). The 2 heads join together in the distal arm to form one strong tendon, which inserts on the radial tuberosity on the upper end of the radius.

Distally, the tendon gives off the bicipital aponeurosis (an expansion that blends with the flexor forearm muscles, extending to the ulna).

The biceps brachii is innervated by the musculocutaneous nerve (C5, C6). The actions of the biceps brachii muscle is flexion of the elbow, supination of the forearm, humeral head depression, and shoulder flexion (short head primarily).

Diagnosis of Biceps Tendonitis

Diagnosis is primarily clinical. Patient history suggests the diagnosis. Pain is reported in the region of the anterior shoulder located over the bicipital groove, occasionally radiating down to the elbow.