Biceps tendinopathy is irritation and wear of the biceps tendon, most often the long head where it runs through a groove at the front of the shoulder. It causes pain at the front of the shoulder, especially when lifting.
The biceps muscle at the front of the upper arm has two tendons at the shoulder. The long head tendon runs in a groove at the top of the arm bone and attaches inside the shoulder joint. With repeated lifting, reaching or overhead use, this tendon can become painful and thickened. This is called tendinopathy. It often happens together with other shoulder problems, such as rotator cuff tendinopathy or shoulder impingement.
A separate problem is a tear of the biceps tendon at the elbow (distal biceps rupture). This usually happens with a sudden heavy lift and causes a pop, bruising and weakness at the front of the elbow. It needs an urgent orthopaedic opinion, as surgical repair, if chosen, is usually done early. The clinic will refer you. This page focuses on biceps tendinopathy at the shoulder.
The doctor asks about your symptoms and activities and examines the shoulder. Specific movement tests help show whether the biceps tendon, rotator cuff or other structures are the main source of pain.
An ultrasound scan can show thickening of the biceps tendon, fluid around it and whether it sits normally in its groove. It can also check the rotator cuff, which is often involved.
An X-ray or MRI can be arranged by referral if the doctor suspects a tear, a labral injury or another structural problem.
Your plan depends on what the assessment finds. These are the options we most often discuss.
Cutting back on heavy lifting and overhead activity for a period, while staying active, often helps the tendon settle.
A graded programme to strengthen the rotator cuff, shoulder blade and biceps, and to gradually reload the tendon, is usually the main treatment.
Learn moreHands-on treatment to the shoulder and surrounding muscles may help ease pain and stiffness, alongside an exercise programme.
Learn moreWhere assessed as suitable, an ultrasound-guided injection around the tendon sheath may reduce pain for a period so rehabilitation can progress. It is not injected into the tendon itself, and repeated injections are generally avoided.
Learn moreSimple pain relief or anti-inflammatory medicines may help for a short time, where suitable for you.
If symptoms persist despite good non-surgical care, or there is a significant tear, the clinic will refer you to an orthopaedic surgeon to discuss surgical options.
Many people improve over six to twelve weeks with activity changes and a regular exercise programme. Tendons often respond slowly, so progress may feel gradual, and some people take several months to return fully to heavy lifting or overhead sport. Recovery can take longer, and time frames vary, when rotator cuff problems are also present. Returning to full load gradually, rather than all at once, may help reduce the chance of symptoms flaring again.
Tendinitis suggests inflammation, while tendinopathy is a broader term for a painful, irritated tendon. Long-standing tendon pain often involves changes in the tendon structure rather than only inflammation. For this reason, many clinicians now use the term tendinopathy.
A tear of the long head tendon can cause a sudden pop, bruising and a lower bulge in the upper arm, sometimes called a 'Popeye' sign. Many people keep good arm function and are managed without surgery, but you should be assessed promptly. Your doctor can advise whether an orthopaedic opinion is needed.
A tear of the biceps tendon at the elbow often causes lasting weakness in turning the palm up and bending the elbow. Surgical repair may be recommended, and it is usually more straightforward when done early. This is why it needs an urgent orthopaedic referral rather than a wait-and-see approach.
Often yes, with changes. You may need to reduce or avoid heavy pressing, pulling and curling for a while and focus on exercises that do not cause pain. Your doctor can help you plan which exercises to keep and how to build back up.
No. Inflexion Clinic is a private GP clinic, so you can book directly. Book online or call the clinic on +65 8997 0659.
Our clinicians will take a proper history, examine you, and give you a clear plan on the day.