Biceps tendinopathy

Overview

what it is and why it matters

Shoulder joint anatomy showing the humeral head, glenoid socket, and rotator cuff muscles (supraspinatus and infraspinatus). — **Shoulder anatomy.** The shoulder is a shallow ball-and-socket joint. The top of the upper-arm bone (humerus) sits against a small dish on the shoulder blade (glenoid), and four rotator-cuff tendons wrap around the ball to hold it centered during every arm motion.

The long head of the biceps (LHB) tendon originates from the superior glenoid labrum (SLAP region) and travels through the bicipital groove of the humerus. It is exposed to significant mechanical stress within this groove during overhead activities. Biceps tendinopathy — inflammation and degeneration within the tendon — is common in middle-aged adults and overhead athletes, and frequently accompanies rotator cuff tears and subacromial impingement.

Diagnosis

exam first, imaging second

Anterior shoulder pain in the bicipital groove, worse with overhead activity and forearm supination. Speed's test (resisted forward flexion with elbow extended and forearm supinated) and Yergason's test (resisted supination with elbow at 90°) are positive. Ultrasound effectively visualizes tendon thickening, fluid, and partial tearing in the groove. MRI evaluates associated SLAP tears and rotator cuff involvement.

Treatment Path

how care progresses at OSI

Activity modification

Reducing overhead and heavy-lifting activities.

Physical therapy

Shoulder stabilizer strengthening reduces mechanical stress on the biceps tendon.

NSAIDs

Anti-inflammatory management.

Bicipital groove injection
Ultrasound-guided corticosteroid injection adjacent to the tendon in the groove — effective for acute tendinitis.

Surgical Options at OSI

if non-operative care isn't enough

Refractory biceps tendinopathy with significant tendon degeneration, or tendinopathy occurring with a concurrent rotator cuff repair, is addressed with tenotomy or tenodesis.

Primary procedure

Biceps tenodesis

The tendon is released from its origin and re-fixed to the humerus (in the groove or subpectorally) — preserves cosmesis and strength; preferred in younger, active patients.

Overview

Diagnosis

Treatment Path

Activity modification

Physical therapy

NSAIDs

Bicipital groove injection

Surgical Options at OSI

Providers Who Treat Biceps Tendinopathy

Michael S. Vrana, M.D.

David B. Templin, M.D.

Trent Twitero, M.D.

Further Reading

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