As the long head of the biceps tendon get inflamed and irritated, patients may experience various symptoms related to biceps tendinitis. Intermittent or constant shoulder pain in the front of the shoulder with pain or achiness moving down the arm towards the elbow is common. Sometimes snapping or popping can be heard or felt in the front of the shoulder as well. The pain may worsen with raising the affected arm out in front of the body or when raising the arm above their head. This pain with movement may be accompanied by tenderness when touching the front of the shoulder. Sometimes, this damage to the biceps tendon can cause a tear or rupture of the tendon, resulting in a deformity of the biceps muscle referred to as a “Popeye” sign. Though the appearance of the arm is altered, strength typically remains largely unaffected once the pain improves.

Biceps tendinitis can affect people of all ages. It often occurs in athletes competing in sports requiring repetitive overhead motion, such as baseball pitchers, tennis players and swimmers. It can also occur in active older patients as a normal part of aging or people whose work or recreational activity requires repetitive motions overhead.

Most cases of biceps tendinitis result from overuse or repetitive microtrauma that causes small tears and inflammation in the biceps tendon. Jobs and daily chores requiring overhead motion can slowly weaken the tendon over time and produce inflammation. Overuse may lead to degeneration and damage of the biceps tendon. In addition, athletes involved in sports requiring repetitive overhead motions are particularly at risk for biceps tendinitis.
Biceps tendinitis also can occur with other overuse injuries to the shoulder, including rotator cuff injuries, osteoarthritis, and shoulder instability. When other structures of the shoulder are injured, the long head of the biceps may work as an additional stabilizer of the shoulder joint, which can cause it to become inflamed.

The evaluation begins with a complete history of your symptoms and thorough physical exam. Additional diagnostic imaging studies, such as ultrasound or MRI, can be performed to evaluate the biceps tendon as well as look for additional pathology in the shoulder. Signs of biceps tendonitis on clinical examination include tenderness in the front of the shoulder as well as pain with certain movements that stress the biceps tendon.

Initial management for most patients with biceps tendinitis is conservative with rest, ice, activity modification, oral/topical anti-inflammatory medications, and conditioning exercises to stretch and strengthen the shoulder with the help of a well-trained physical therapist. Additionally, corticosteroid injections can be administered to the tendon which serve to calm down the inflammation, provide pain relief, and allow for more benefit with therapy and home exercise. If non-surgical treatment options fail to provide lasting relief, surgery may be recommended as the next step in treatment. The surgical procedure is called a biceps tenodesis. The goals of the procedure are to remove the damaged portion of the biceps tendon and to re-attach the remaining tendon to the upper arm bone, the humerus. By removing the injured portion of the tendon, pain and inflammation is decreased. In the majority of cases, a biceps tenodesis allows for restoration of normal shoulder motion and function without pain.
In cases where the biceps tendon cannot be repaired via tenodesis, the damaged biceps tendon may be released from its attachment site in the shoulder joint. This tendon release is referred to as a biceps tenotomy. Though a biceps tenotomy may result in a Popeye deformity in the arm, patients usually do well and return to normal function without pain.