What Is Biceps Tendinopathy?

Biceps tendinopathy describes pain and changes involving a biceps tendon. At the shoulder, it most commonly involves the long head of the biceps tendon.

Many people still use the term biceps tendonitis. However, clinicians often use tendinopathy because tendon pain can occur without active inflammation.

A partial or complete biceps tendon rupture is different from tendinopathy and may require earlier medical assessment, particularly after a sudden injury.

Where Is the Biceps Tendon?

The long head of the biceps tendon passes through the front of the shoulder and attaches near the top of the shoulder socket. The biceps contributes to elbow bending and forearm rotation and can also contribute to shoulder function.

The long head of the biceps is closely related to the rotator cuff and superior labral region. Biceps tendon pathology may therefore occur alongside other shoulder conditions, particularly rotator cuff pathology.1,2

Symptoms of Biceps Tendinopathy

Biceps tendinopathy often causes pain at the front of the shoulder during loaded arm movements. Symptoms vary between people and may overlap with other shoulder conditions.

• Pain at the front of the shoulder, sometimes extending into the upper arm.
• Pain with lifting, pulling, pushing or carrying.
• Pain with repeated reaching or overhead activity.
• Pain with resisted elbow bending or forearm rotation.
• Night pain or discomfort when lying on the affected side.
• Pain during gym, work, swimming, throwing or other repetitive arm activities.
• Clicking or snapping sensations in some presentations.

What Causes Biceps Tendinopathy?

Biceps tendon symptoms can develop when the demands placed on the shoulder exceed its current capacity. Symptoms may build gradually with repeated loading or appear after a substantial change in training, work or sport.

Factors that may be relevant include:

• a sudden increase in training or workload;
• repeated or heavy lifting, pulling or reaching;
• repetitive overhead activity;
• throwing, swimming, gymnastics, racquet sports or other high-load shoulder activities;
• reduced strength or capacity following a period of lower activity; and
• associated shoulder problems such as rotator cuff pathology or shoulder instability.

Individual presentations differ. Shoulder movement, strength, training history, work demands and other contributing factors can therefore be considered during assessment rather than assuming that one movement pattern caused the problem.

A structured exercise load management plan can adjust training volume, resistance, range, speed and recovery while shoulder capacity is rebuilt.

How Is Biceps Tendinopathy Assessed?

A physiotherapy assessment may examine the history of your symptoms, shoulder and neck movement, strength, tendon sensitivity and the activities that reproduce your pain. Rotator cuff function and other shoulder structures may also need assessment because several conditions can produce similar symptoms.

No single symptom or physical test necessarily proves that the biceps tendon is the only source of pain. Assessment therefore considers the overall clinical pattern rather than relying on one test alone.

Ultrasound or MRI may be considered when symptoms persist, several structures may be involved or a significant tendon injury is suspected. Imaging findings do not always match pain severity, so results should be interpreted alongside the history and physical assessment.3

Biceps Tendinopathy or Another Shoulder Problem?

Front shoulder pain does not automatically mean that the biceps tendon is the only structure involved. Several shoulder conditions can produce overlapping symptoms.

How Is Biceps Tendinopathy Treated?

Management commonly combines activity modification and progressive exercise rehabilitation. The aim is to reduce unnecessary aggravation while rebuilding the shoulder’s ability to tolerate work, sport and everyday activity.3,4

1. Adjust Irritating Loads

Early management usually involves identifying activities that repeatedly aggravate symptoms. The aim is not necessarily to stop using the arm. Instead, loads can be adjusted so that useful activity continues without repeatedly provoking a substantial flare.

Depending on the presentation, temporary changes may include:

• reducing heavy or repetitive lifting;
• changing painful pressing or pulling exercises;
• temporarily modifying overhead work or sport;
• adjusting training volume, range or resistance;
• changing sleep position when night pain is troublesome; and
• using simple short-term symptom-relief strategies where appropriate.

2. Rebuild Strength and Capacity

Exercise rehabilitation may include progressive biceps loading, rotator cuff strengthening and exercises that develop shoulder and shoulder blade capacity. The appropriate starting point depends on your symptoms, strength, current activity and rehabilitation goals.3,4

Exercise may progress through:

• comfortable isometric or isotonic biceps loading;
• progressive resistance exercises;
• rotator cuff and shoulder strengthening;
• increasing load through useful ranges of movement; and
• gradual return to pressing, pulling, throwing, swimming, work or sport-specific loads.

See rotator cuff exercises and shoulder exercises for related rehabilitation information.

3. Address Other Contributing Factors

Biceps tendon symptoms can occur alongside a broader shoulder problem. Rehabilitation may therefore address other relevant findings rather than treating the biceps tendon in isolation.

Depending on the assessment, this may include rotator cuff strength, shoulder capacity, activity technique, training load or other factors relevant to your work or sport.

4. Check the Neck When Appropriate

Neck-related pain can sometimes be felt around the shoulder or upper arm. A neck assessment may therefore be appropriate when the symptoms, history or examination suggest that the cervical spine could contribute to the pain pattern.

Related information: neck pain.

5. When Might Medical Treatment Be Considered?

Some people with persistent biceps-related shoulder symptoms may discuss other treatment options with their doctor or specialist. These can include injections or, in selected cases, surgery.

Surgical procedures such as biceps tenotomy or tenodesis may be considered for particular biceps tendon problems, significant associated pathology or persistent symptoms that have not responded adequately to appropriate non-surgical management.5

When Should You Seek Help?

Consider a physiotherapy assessment when front shoulder pain is persistent, recurrent or interfering with work, training, sport, sleep or normal daily activity. Assessment can help determine whether the biceps tendon or another shoulder or neck problem may be contributing.

Seek Earlier Assessment After a Significant Injury

Earlier medical or physiotherapy assessment is appropriate if a sudden shoulder or arm injury causes:

• significant bruising;
• sudden loss of strength;
• an obvious change in the shape of the biceps;
• difficulty lifting or using the arm normally; or
• substantial pain following significant trauma.

Biceps Tendinopathy FAQs

What to Do Next

If shoulder pain is limiting your work, training, sport, sleep or everyday activities, a physiotherapy assessment can help identify the likely contributors and establish a practical rehabilitation plan.

Book online 24/7 and choose the PhysioWorks clinic that suits you.

References

1. Lalehzarian SP, Sheth U, et al. Management of proximal biceps tendon pathology. Orthop Res Rev. 2022.
2. Ardebol J, et al. Long head of biceps tendon management with rotator cuff pathology. JSES Rev Rep Tech. 2024.
3. McDevitt AW, Cleland JA, Addison S, Calderon L, Snodgrass S. Physical therapy interventions for long head of biceps tendinopathy. 2023.
4. McDevitt AW, Cleland JA, Addison S, Calderon L, Snodgrass S. Physical therapy interventions for the management of biceps tendinopathy: an international Delphi study. Int J Sports Phys Ther. 2022;17(4):677-694.
5. Hartland AW, et al. Tenotomy vs tenodesis for biceps pathology. BMJ Open. 2022.