Biceps Tendinopathy

Biceps tendinopathy is an overload/overuse condition of the long head of biceps tendon which originates from the cartilage structure of the shoulder socket (labrum) and is positioned within a groove in the upper arm bone (humerus) known as the bicipital groove. It has been put forward that this tendon may play a role in shoulder stability as a proposed 5^th rotator cuff muscle. However, it’s main role is assisting the initiation of raising your arm forward whilst being one of two tendons which form the biceps for elbow flexion.

• Gradual symptom onset though a period of increased activity/load in the affected shoulder.

• Usually reported as a deep, throbbing pain located in the anterior region (front of the shoulder).

• Symptoms provoked with overhead activity, lifting, pulling and repeated movements.

• Worse overnight, notably when lying on the affected side.

• In some cases, a ‘popping’ or ‘clicking’ sensation when moving the shoulder.

Biceps tendinopathy typically develops from relative sudden overload. In these cases of increased activity, repetitive damage at a microscopic level leads to degeneration & weakness, reduced function and pain which is common in most tendon overload conditions (Snyder, Mair & Lattermann 2012).

There are also other factors which have been associated with the development of this condition. Ligament thickening around the anterior (front) shoulder region has been linked to biceps tendinopathy as well as narrowing of the sub-acromial space or impingement in this area.

Previous and persistent rotator cuff tears have also been proposed as a common cause particularly in anterior cuff tear – Subscapularis. Lastly, as previously mentioned, the tendon is positioned in a groove which is also known as the inter-tubercular sulcus of the humerus. There is a ligament which keeps the long head of biceps tendon in position known as the transverse humeral ligament. These issues can alter the way the shoulder joint moves which can increase the mechanical load placed on the tendon. Similarly, if the muscles around the shoulder become weak or do not function optimally, instability can occur which may also lead to overload and increased wear & tear.

The development of biceps tendinopathy has shown to be common in those performing repeated throwing actions. This movement where the arm is outstretched and rotated backwards, can compress the biceps tendon causing irritation and compression. It is most common in the sporting population aged between 18 – 35. 95% of those who develop this condition present with an associated rotator cuff tear or SLAP lesion which refers to a tear of the cartilage ring in the shoulder socket (superior labrum anterior to posterior).

To summarise, biceps tendinopathy commonly presents alongside accompanying shoulder pathologies and tends to develop from changes in the biomechanics and stability of the shoulder joint.

To help diagnosis, your Physiotherapist will take a detailed history of your symptoms to ascertain factors linked to your symptom development. After obtaining information about your current symptoms, your clinician will perform a full physical assessment to yield a precise diagnosis. Our expert and skilled clinicians will examine your shoulder function and strength, carry out special tests and clear the neck, elbow and wrist to rule out other conditions which could present similarly. At Pure, we will provide you with a fast and accurate diagnosis so that the correct treatment and management can be implemented to help you recover and return to your normal levels of activity and function.

Following your diagnosis of Biceps Tendinopathy, you will be given information on the condition and what can be done to help with your recovery. One element of this may be activity modification strategies to avoiding aggravating activities like reaching overhead and out sideways as recommended by Nho et al. (2010). We also understand that maintaining a livelihood and remaining in work is more essential than ever. As such, your Physiotherapist can suggest ways in which you can continue to perform your normal occupational activities in ways which may be less irritable or prevent symptom aggravation. Your clinician can also recommend ways of reducing symptoms such as advice on over-the-counter medication and the use of heat or ice.

Your Physiotherapist will design a bespoke home exercise plan coupled with providing knowledge and skills to help manage it independently. Your personalised rehabilitation programme will comprise of exercises to develop shoulder strength and stability based on your individual needs which will help to offload the long biceps tendon.

Acupuncture, soft tissue mobilisation and manual therapy – which involves passive movement of the joints, may be implemented as part of your treatment to help reduce discomfort and increase range of motion should any deficits be identified.

Through regular re-assessment, your Physiotherapist can check your progress in relation to the goals you have made and can make adjustments to your exercises so they remain effective at improving shoulder strength and function. As you progress through your recovery, you will be given ongoing advice and support to continue to manage your symptoms effectively, and to prevent re-occurrence.

Nho, S. J., Strauss, E. J., Lenart, B. A., Provencher, M. T., Mazzocca, A. D., Verma, N. N., & Romeo, A. A. (2010). Long head of the biceps tendinopathy: diagnosis and management. Journal of the American Academy of Orthopaedic Surgeons, 18(11), 645-656.

Snyder, G. M., Mair, S. D., & Lattermann, C. (2012). Tendinopathy of the long head of the biceps. Rotator Cuff Tear: Karger Publishers, Vol. 57, p 76-89.