Biceps Tendinopathy

Bicep Tendinopathy

Article by J.Miller, S.Armfield

Biceps Tendinopathy

(Biceps Tendonitis/Biceps Tendinitis)

What is Biceps Tendinopathy?

biceps tendonitis

Biceps tendinopathy is the umbrella term for biceps injuries that include:

  • Biceps tendonitis/tendinitis (inflammed tendon).
  • Biceps tendinosis (non-inflammed degenerative tendon).
  • Biceps tenosynovitis (inflammed tendon sheath).
  • Ruptured biceps tendon (secondary to degeneration or tear).

Old habits die hard, and biceps tendinopathies have a history of being called biceps tendonitis or tendinitis. Modern physiotherapist and doctors will describe injuries as biceps tendinopathy.

Where is your Biceps Tendon?

The anatomy of the biceps muscle is essential in understanding biceps tendinopathy. The biceps brachii has two heads: short and long. It is predominately the long-head of biceps that becomes symptomatic.

The biceps’ long head passes over the humerus head (ball joint) and attaches to the shoulder socket’s top. The biceps’ long head acts as a shoulder joint stabiliser through a depression of the humeral head. The biceps tendon travels through the bicipital groove on the front of the shoulder ball, where most inflammation – usually friction-related – occurs. If inflammation is the cause, you will have either biceps tendonitis or tenosynovitis.

What Causes Biceps Tendinopathy?

Biceps tendinopathy is rare in isolation. Overuse, tendon impingement, shoulder joint instability or trauma predispose you. Therefore, it coexists with other shoulder pathologies, including rotator cuff impingement syndrome, rotator cuff tears, labral tears, SLAP lesions and shoulder instability. It is common in sports that involve throwing, swimmers, gymnasts and some contact sports. Occupations that require overhead shoulder work or heavy lifting are at risk.

What are the Symptoms of Biceps Tendinopathy?

Bicep tendonitis and tendinopathy sufferers will commonly report:

  • Pain in the anterior shoulder region located over the bicipital groove, occasionally radiating down to the elbow.
  • Overhead activities usually reproduce pain, especially those positions that combine abduction and external rotation, e.g. cocking to throw.
  • The pain aggravates with shoulder flexion, forearm supination, or elbow flexion.
  • Some patients describe muscle weakness and clicking or snapping with shoulder movements.
  • The symptoms alleviate with rest and ice.

How is Bicep Tendinopathy Diagnosed?

Based on your symptoms and history, your physiotherapist or doctor may suggest biceps tendinopathy. Ultrasonography and MRI are the best investigations to confirm the diagnosis. For specific diagnostic advice for your shoulder injury, please consult your trusted shoulder healthcare practitioner.

Bicep Tendinopathy Treatment

Treatment depends on the type of tendinopathy. Notably, the cause of your tendinopathy needs addressing.

Special Considerations

Biceps tendonitis/tendinitis (inflammed tendon), Biceps tenosynovitis (inflammed tendon sheath).

Due to the inflammatory nature, tendonitis may respond favourably to non-steroidal anti-inflammatory medications (NSAIDs) or cortisone injections. Ice may relieve pain and reduce swelling.

Biceps tendinosis (non-inflammed degenerative tendon).

Due to the non-inflammatory nature, tendinosis is unlikely to respond to (NSAIDs) or cortisone injections. They may be detrimental and delay healing in tendinosis suffers. These require special tendon strengthening exercises that your physiotherapist will advise.

Ruptured biceps tendon (secondary to degeneration or tear).

Referral to an Orthopaedic Surgeon, especially if the rupture is recent.

Pain Relief

You’ll most likely be unable to lift your arm or sleep comfortably fully in the early phase. The first aim is to provide you with some active rest from pain-provoking postures and movements. Active rest means that you should stop doing the action or activity that provoked the shoulder pain in the first place and avoid doing anything that causes pain in your shoulder.

You may need to have your shoulder specially taped to provide pain relief. In some cases, it may mean that you need to sleep relatively upright or with pillow support. Your physiotherapist will guide you.

Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.

Your physiotherapist will utilise a range of pain-relieving techniques, including joint mobilisations, massage, acupuncture or dry needling, to assist you during this pain-full phase.

Patient Education & Technique Correction

You must understand why you have developed bicipital tendinopathy. Your physiotherapist will discuss with you what activities and postures are likely to aggravate your condition. They may also need to modify your technique or training/work volume.

Range of Motion & Flexibility

Your physiotherapist will assess your muscle and joint flexibility and prescribe exercises or recommend massage to attain a reasonable range of motion.

Improve Joint Stability & Strength

Your physiotherapist will need to address your scapulohumeral and scapulothoracic stability and movement function. Since glenohumeral joint instability is a significant cause of bicipital tendinopathy, exercises may include:

  • Biceps strengthening
  • Rotator cuff strengthening.
  • Scapular stabilisation
  • Periscapular strengthing
  • Scapulohumeral rhythm correction.

In severe cases, surgical stabilisation may correct significant passive instability, e.g. previous dislocation.

Neck & Thoracic Posture & Mobility

Your neck and upper back have a link to your shoulder blade posture and dynamic control. In some cases, joint stiffness or pain referred from inflammed neck joints can directly alter shoulder pain and function. Your physiotherapist is skilled at the assessment and treatment of neck and upper back dysfunction. Ask them for more specific advice.

Restore Normal Function: Speed, Load, Power & Proprioception

Your physiotherapy treatment will vary depending on the functional requirements that you specifically need for your shoulder.

If your shoulder injury has a sporting origin, it is usually during high-speed activities, which place enormous forces on your body (contractile and non-contractile) or repetitive actions.

To prevent a recurrence as you return to sport, your physiotherapist will guide you with exercises to address these critical components of rehabilitation to avoid repeat episodes and improve your sporting performance.

Depending on what your sport or lifestyle entails, to prepare you for light sport-specific training, you may require a speed, agility, proprioception and power program.

Bicep Tendinopathy Prognosis

Bicipital tendinopathies rehabilitate successfully. Even biceps tendon ruptures do not always require surgery with a physiotherapist-guided rehabilitation program and can rehabilitate to resume excellent shoulder function.

In general, the inflammatory versions (tendonitis and tenosynovitis) will respond quicker. Degenerative tendinosis already has tendon cell death and require a longer-term rehabilitation strategy. It is essential to rehabilitate these tendon injuries as well as possible. These are the most likely to rupture in the future.

Due to the cause of tendinopathy usually being coexisting rotator cuff impingement or shoulder instability, the timeframe can vary widely.

Return to Sport or Work

Depending on the demands of your chosen sport or your job, you will require specific sport-specific or work-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport or employment.

Your PhysioWorks physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport or work.

The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a thorough rehabilitation program has minimised your chance of future injury.


There is no specific time frame for when to progress from each stage to the next. Many factors will determine your injury rehabilitation status during your physiotherapist’s clinical assessment.

You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.

It is also important to note that your physiotherapist monitors each progression. Attempting to progress too soon to the next level can lead to re-injury and frustration.

For more specific advice about your biceps tendinopathy, please contact your PhysioWorks physiotherapist.

Common Shoulder Pain & Injury Conditions

Rotator Cuff

Adhesive Capsulitis

Shoulder Bursitis

Shoulder Instability

Acromioclavicular Joint

Bone Injuries

Post-Operative Physiotherapy

Muscle Conditions

Systemic Conditions

Referred Pain

Shoulder Treatment

Researchers have discovered that managing your shoulder injury with physiotherapy is usually successful. Typically, you have two options: a non-operative or a surgical approach. Your condition will dictate which option is best for you at this time. Non-operative care is conservative rehabilitation.

If shoulder surgery is required, then your physiotherapist may undertake:

Pre-operative rehabilitation  - to either trial a non-operative/conservative treatment approach or condition and prepare your shoulder and body for a surgical procedure.

Post-operative physiotherapy will safely regain your normal range of movement, strength and function.

PhysioWorks physiotherapists have a particular interest and an excellent working relationship with leading shoulder surgeons. Our physiotherapy team provide you with both conservative and post-operative shoulder rehabilitation options. We aim for you to attain the best possible outcome for your shoulder injury.

For specific information regarding your shoulder, please consult your trusted shoulder physiotherapist.

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