Long Head of Biceps Tendinitis is a painful condition resulting from inflammation of the tendon of the long head biceps muscles.1 The long head tendon of biceps originates from the superior surface of shoulder joint known as glenoid tubercle. Thus, any shoulder joint movement causes severe pain along long head of biceps because of irritation of the inflamed long head tendon. Severe pain over the shoulder joint is often mistaken for shoulder joint arthritis. The inflammation of the long head tendon of biceps restricts the shoulder joint movement.1
This article discusses about:
- What is Long Head of Biceps Tendinitis?
- Causes of Long Head of Biceps Tendinitis
- Symptoms of Long Head of Biceps Tendinitis
- Diagnosis of Long Head of Biceps Tendinitis
- Treatments for Long Head of Biceps Tendinitis
- Exercises for Long Head of Biceps Tendinitis.
Long Head Of Biceps Tendinitis
- Long Head of Biceps Tendinitis is the name given for inflammation of the long head biceps tendon.
- Long head of biceps tendon originates from supra-glenoid tubercle of scapula just adjacent to shoulder joint.
- Origin of biceps muscle has second strip known as short head, which originates from coracoid process of scapula adjacent and above shoulder joint.
- The tendon becomes muscle below the shoulder joint and lies in front of upper arm as it spreads towards the elbow joint.
- The muscle is attached to radius at radial tuberosity and spreads over antebrachial fascia as bicipital aponeurosis.
- Contraction of the biceps muscles results in flexion and supination of the forearm at the elbow joint.
- The inflammation of the tendon interferes with shoulder joint movement as well as elbow joint movements. The contraction of the muscles while tendon is inflamed causes severe pain and muscle spasm.
Causes Of Long Head Biceps Tendinitis
- Chronic Shoulder Joint Arthritis- Severe shoulder joint rheumatoid or osteoarthritis causes inflammation of the joint, cartilage and tendon. The joint inflammation spreads over adjacent soft tissue like long head tendon of biceps and results in inflammation of long head of biceps.
- Glenoid Labrum Rupture- Longhead of biceps originates from supra-glenoid tubercle, which is adjacent to glenoid labrum or joint capsule. The rough surface caused by tear or rupture of glenoid labrum irritates the long head of biceps during shoulder joint movements and eventually results in inflammation of long head of biceps.
- Work Injury- Repetitive Shoulder joint rotation and movement among manual workers causes injury of the long head of biceps. Continuous hammering or loading and unloading results in multiple shoulder joint movements and rotations, which causes excessive friction of biceps tendon. The friction of tendon causes irritation and initiates inflammatory reaction within tendon fibers.
- Sports Injury- Like work injury repetitive movement of shoulder joint is also observed in tennis player and baseball pitcher. Such movement eventually causes biceps longhead tendon to be inflamed and symptomatic restricting joint movement.
- Direct Impact of the Shoulder Joint- Shoulder joint direct impact is seen in automobile or car accident and sports injury. Direct impact of shoulder joint under long head tendon of biceps causes injury of long head tendon and shoulder joint. Injury results in tendon inflammation.
- Rotator Cuff Tear- The biceps tendon inflammation is frequently observed in patient suffering with rotator cuff tear.2
Symptoms & Signs Of Long Head Of Biceps Tendinitis
- Pain that often lasts over 3 to 6 months is known as chronic pain. Pain starts as mild to moderate and if not treated become severe.
- Pain is often continuous following treatment because of scarring of the inflamed tendon. Pain is often absent at rest and when shoulder joint is not moving.
- Pain become severe and lasts for prolonged time when long biceps tendon is palpated or pressed during examination.
- Pain also last longer following any attempt to lift weight using disease arm.
Audible Snapping of the Shoulder-
- In the early stage of inflammation long head of biceps tendon movement of shoulder joint is associated with snapping sound.
- Pain is continuous following the snapping of the long head at the shoulder joint.
- Snapping is often observed in patients suffering with arthritis or following shoulder joint injury.
- Snapping is caused by friction of the long head with injured or rough surface of the capsule or glenoid.
- Muscle Spasm- The pain over long head of biceps tendon results in continuous prolonged contraction of deltoid and surrounding muscles. The fatigued muscle often results in spasm and severe pain.
- Tender and Inflamed Muscles- The skin and subcutaneous tissue over the inflamed muscle is tender and warm. The occasional reddish skin discoloration over long head biceps tendon is observed when inflammation is severe and wide spread.
Diagnosis Of Biceps Tendinitis
Clinical Examination- Following symptoms and signs are observed when long head biceps tendon is inflamed.
- Sever pain over shoulder joint
- Pain become severe and continuous when long head of biceps tendon is palpated.
- Restricted shoulder joint movement.
- Severe pain is initiated following supination and flexion of forearm at elbow joint against resistance.
- X-Ray Examination-
- X-ray does not show soft tissue.
- X-ray examination is done to rule out fracture and dislocation of shoulder joint.
- MRI Examination-
- MRI of the soft tissue does show long head of biceps tendon. The diseased long head of biceps is compared with opposite arm long head biceps. The difference in shape and size may suggest presence of tendon inflammation.
- Ultrasound study of both shoulder joint and biceps tendon gives the image of normal long head of biceps and diseased long head of biceps.3
- The presence of swelling and edema (increase fluid retention) of long head biceps tendon concludes the diagnosis.
Shoulder Joint Arthroscopy-
- Shoulder joint arthroscopy is performed as a diagnostic procedure when all other studies are not conclusive.4
Treatment For Long Head Of Biceps Tendinitis
Long Head of Biceps Tendinitis can be treated both conservatively as well as surgically.
Nonsurgical Treatment For Long Head of Biceps Tendinitis
Restrict The Shoulder Joint Movement-
- Shoulder joint movement is restricted to assist healing of the inflamed long head of biceps tendon.
- Restriction also helps to prevent friction of the tendon with joint surface.
Cold Therapy For Long Head of Biceps Tendinitis-
- Application of ice or cold pack over the shoulder helps to reduce swelling and edema.
- Ice pack also helps to reduce pain.
- Ice pack is applied for 30 minutes every 4 to 6 hours.
Medications For Long Head of Biceps Tendinitis-
- NSAIDs are anti-inflammatory medications prescribed for inflammation and pain.
- NSAIDs are helpful to relieve mild to moderate pain.
- Most common NSAIDs prescribed are Motrin, Naproxen and Celebrex.
- Opioid are addictive in few individual and causes several undesirable side effects like nausea, vomiting and constipation.
- Opioids are prescribed for severe pain, which is not responding to NSAIDs.
- Opioid prescriptions are limited to 2 to 3 weeks since cause of pain is inflammation. Pain intensity is less severe once inflammation is treated and opioid therapy may not be necessary.
- Most common Opioids prescribed are Hydrocodone (Vicodine and Norco) and Oxycodone (Percocete).
- Muscle Relaxants:
- Muscle spasm is treated with muscle relaxants.
- Most common muscle relaxants used are Baclofen, flexeril and skelaxin.
- Steroid Injection:
- Severe inflammation and pain is occasionally treated by cortisone injection over the long head biceps tendon.3
- Procedure is done in doctor’s office or surgical center.
- Pain specialist, Physical Medicine Rehab Physician or Orthopedic Surgeon, performs procedure.
- Frequent cortisone injection is avoided.
- Pain relief is instant and lasts for 3 to 6 weeks.
Physical Therapy (PT) For Long Head of Biceps Tendinitis
- Physical Therapy is indicated during the inflammation and after healing from inflammation.
- Physical therapy during inflammation of long head of biceps is indicated to prevent atrophy of the adjacent shoulder joint muscles as well as muscles of forearm.
- Physical therapy after the cure of inflammation of long tendon of biceps is indicated to rehabilitate biceps muscles. The physical therapy is directed to build the atrophied muscle mass and improve function of biceps muscles.
Surgical Treatment For Long Head of Biceps Tendinitis
- Arthroscopic surgery is rarely necessary.
- Arthroscopy is used for diagnosis and also treatment.
- The surgery is necessary only if tendon is torn or ruptured.
- The two segments of torn tendon are approximated and sutured.
Open Surgical Repair-
- Biceps Tenodesis:
- The tendon is exposed following incision.
- The damaged tendon is excised and removed.
- The healthy tendon is reattached to the humerus.
- This procedure can be done both arthroscopically as well as through an open incision.
- The procedure involves excision of biceps tendon.
- Shoulder Arthroplasty- Arthroplasty is performed when all other treatment has failed and pain is continuous and severe. Arthroplasty involves replacement of entire shoulder joint.5
Exercises For Long Head Of Biceps Tendinitis
Shoulder Blade Squeezes: To do this exercise, start by standing tall with the back straight. Squeeze the shoulder blades together as much as possible without aggravating pain. Maintain this position for about 5 seconds and repeat around 10 times.
Pendular Exercises: Start this exercise by leaning forwards with uninjured arm placed on a table. Keep the back straight and relax the shoulder. Now, gently swing the affected arm forward and backward as far as possible without aggravating pain. Do it for around 10 times. Now, do the same exercise by moving the arm sideways.
1. Tendinopathy of the long head of the biceps.
Snyder GM1, Mair SD, Lattermann C.
Med Sport Sci. 2012;57:76-89.
2. The role of the biceps tendon in massive rotator cuff tears.
Pill SG1, Walch G, Hawkins RJ, Kissenberth MJ.
Instr Course Lect. 2012;61:113-20.
3. Diagnosis and treatment of biceps tendinitis and tendinosis.
Am Fam Physician. 2009 Sep 1;80(5):470-6.
4. The incidence of pathologic changes of the long head of the biceps tendon.
Murthi AM1, Vosburgh CL, Neviaser TJ.
J Shoulder Elbow Surg. 2000 Sep-Oct;9(5):382-5.
5. Long head of the biceps pathology as a cause of anterior shoulder pain after shoulder arthroplasty.
Tuckman DV1, Dines DM.
J Shoulder Elbow Surg. 2006 Jul-Aug;15(4):415-8.