Tendinitis (e.g., Biceps Tendinitis)

The long head of the biceps tendon runs from the muscle in the upper arm, through a groove at the front of the shoulder, to attach near the top of the shoulder socket close to the labrum. Because of this course through a narrow groove and its proximity to the rotator cuff, the tendon is prone to irritation and inflammation, known as biceps tendinitis, which is a recognised cause of anterior shoulder pain.

Biceps tendinitis is most often related to repetitive overhead activity, particularly in swimming, throwing sports and manual overhead work. It rarely occurs entirely in isolation, and frequently accompanies rotator cuff impingement or tears, since the biceps tendon travels through the same crowded space beneath the acromion. Age-related tendon wear also contributes, particularly from middle age onward.

Typical symptoms of biceps tendinitis include:

• Pain at the front of the shoulder, sometimes radiating down the front of the upper arm toward the elbow
• Pain that worsens with overhead activity or lifting
• Tenderness directly over the front of the shoulder
• Occasionally, a snapping or popping sensation if the tendon is unstable within its groove

Because biceps tendinitis often occurs alongside rotator cuff problems, assessment typically looks for both together.

Assessment includes examination for tenderness over the biceps tendon and specific tests that reproduce symptoms, along with imaging such as ultrasound or MRI if the diagnosis is unclear or if co-existing rotator cuff pathology needs to be assessed.

Non-surgical treatment is the starting point: activity modification, physiotherapy, anti-inflammatory medication, and a corticosteroid injection into the tendon sheath for more persistent symptoms.

Surgery, biceps tenodesis, is considered for symptoms that persist despite a genuine course of non-surgical treatment, or where the tendon shows significant wear. The procedure relocates and secures the tendon lower down on the humerus, away from the irritated groove.

Most people with biceps tendinitis improve well with non-surgical treatment. Where surgery is needed, biceps tenodesis generally provides reliable relief of anterior shoulder pain, with most patients experiencing good functional recovery.

Biceps tendinitis is a common cause of pain at the front of the shoulder, frequently occurring alongside rotator cuff impingement given the shared anatomy involved. Most cases respond well to non-surgical treatment, and biceps tenodesis offers a reliable option for the minority whose symptoms persist. Persistent front-of-shoulder pain, especially with lifting or overhead activity, is worth having assessed.