Bicep tendon tendonitis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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The biceps tendon runs from its attachment at the top of the glenoid of the scapula through a groove at the top of the humerus (upper arm bone) to the biceps muscle.

While the tendon runs through the shoulder capsule, it is not actually inside the joint. It runs through a tendon sheath lined with synovium. The biceps muscle is responsible for flexing and supinating (turning the forearm so the palm faces up).

(The term "tendinitis" does not always apply to biceps tendon disorders. While "tenosynovitis," meaning inflammation of the synovial sheath the tendon runs through, does occur, most biceps disorders in older individuals (30 years of age and up) actually is due to wear and tear... This is called "tendinopathy.")

For clarity, I'll stick with the word "tendinitis."

Tendonitis commonly develops in patients who do repetitive flexing and extending of the forearm (e.g., using a hammer) or who do repetitive supinating and pronating (turning the forearm so the palm faces down) (e.g., Using a screw driver).

The pain of bicipital tendonitis is felt in the front part of the shoulder. It is aggravated by resisted flexion of the arm.

Swelling and tenderness over the tendon will be noted.

Older people often have coexistent rotator cuff tendonitis as well.

Treatment involves rest, physical therapy, and anti inflammatory drugs. Sometimes steroid injection will be needed. This type of injection should be done using ultrasound guidance in order to ensure accuracy.

Sometimes, steroid injection is not the best approach since it may weaken the tendon and may make it more prone to rupture.

A newer treatment for tendonitis may be safer and more effective. Percutaneous needle tenotomy is a technique where a small gauge needle is introduced using local anesthetic and ultrasound guidance. The needle is used to poke several small holes in the tendon. This procedure is called "tenotomy." Tenotomy induces an acute inflammatory response. Then, platelet rich plasma, obtained from a sample of the patient's whole blood is injected into the area where tenotomy has been performed. Platelets are cells that contain multiple healing and growth factors. The result? Normal good quality tendon tissue is stimulated to grow with natural healing.

In chronic cases of biceps tendonitis, the tendon might rupture. This is usually not a serious problem. It will look peculiar though because the biceps muscle bunches up giving a “Popeye” appearance to the biceps region. Surgery is sometimes performed in patients who require biceps function at a high level.

For more information on tendonitis, visit our sister site:

Tendonitis Tendonitis and provides reliable, accurate, and useful information on tendonitis treatment written by a board-certified rheumatologist. Learn more about how to get tendonitis relief using the most up-to-date methods.

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