What is biceps tendinopathy?
Biceps tendinopathy is a condition involving irritation, inflammation, or degeneration of the tendon of the biceps muscle, most commonly the long head that runs through the front of the shoulder. It typically develops from repetitive overhead activity, heavy lifting, or age-related wear and tear, leading to microdamage in the tendon over time. People with biceps tendinopathy often experience a deep, aching pain in the front of the shoulder that may worsen with lifting, reaching, or rotating the arm, and there can be tenderness along the bicipital groove. In some cases, weakness or a clicking sensation may also be present. If left untreated, the tendon can become more degenerated and, in severe cases, may partially or completely tear. Treatment usually focuses on activity modification, physiotherapy to improve strength and flexibility, and anti-inflammatory measures to reduce pain.
Causes
Biceps tendinopathy is most commonly caused by repetitive strain on the biceps tendon, particularly from activities that involve frequent overhead movements such as swimming, throwing, or weightlifting. Over time, this repeated stress can lead to small microtears and degeneration within the tendon. It is also often associated with other shoulder problems, such as rotator cuff dysfunction or shoulder instability, which can alter normal movement patterns and place extra load on the tendon. Poor posture, especially rounded shoulders, can further contribute by increasing tension on the front of the shoulder. Age-related changes, including reduced blood supply and tendon elasticity, make the tissue more vulnerable to injury. In some cases, a sudden increase in activity level or improper lifting technique can trigger the condition.
Symptoms
Pain in the front of the shoulder: This is the most common symptom and is usually a deep, aching pain located over the bicipital groove. It often worsens with lifting or overhead activitie
Tenderness to touch: Pressing on the front of the shoulder may cause discomfort, especially along the path of the biceps tendon
Pain with overhead or lifting movements: Activities such as reaching up, carrying objects, or lifting weights can aggravate the tendon and increase pain
Pain during twisting or pulling actions: Movements like turning a doorknob, using a screwdriver, or pulling objects can stress the biceps tendon and trigger symptoms
Weakness in the shoulder or arm: The affected arm may feel weaker, particularly during lifting or sustained activity, due to pain inhibition
Clicking or snapping sensation: Some people experience a feeling or sound of clicking in the front of the shoulder when moving the arm, often due to tendon irritation or instability
Pain that worsens gradually over time: Symptoms typically develop slowly and become more noticeable with ongoing activity rather than appearing suddenly
Diagnosis
You surgeon will go through a detailed clinical assessment, starting with a discussion of symptoms and a review of the patient’s activity history, particularly any repetitive overhead or lifting tasks.
They would then perform a physical examination, checking for tenderness over the bicipital groove and using specific shoulder tests that reproduce pain when the biceps tendon is loaded or stretched. Because biceps tendinopathy often occurs alongside other shoulder conditions, the clinician will also assess the rotator cuff and overall shoulder stability.
Imaging
Imaging is used to confirm the diagnosis or rule out associated injuries: ultrasound is commonly the first choice. MRI may be ordered if symptoms are persistent or if more detailed evaluation is needed. In some cases, imaging may also reveal related issues such as labral pathology that contribute to the condition.
Treatment
Conservative (non-operative)
Conservative treatment of biceps tendinopathy focuses on reducing pain, promoting tendon healing, and gradually restoring strength and function. The first step usually involves activity modification, such as avoiding or reducing movements that aggravate symptoms, particularly repetitive overhead lifting or heavy carrying. Rest is often combined with the use of ice or anti-inflammatory measures to help control pain in the early stages. Physiotherapy is a key component of treatment and typically includes gentle stretching to improve shoulder flexibility and progressive strengthening exercises targeting the biceps, rotator cuff, and scapular stabilisers to correct movement imbalances. As symptoms improve, exercises are gradually progressed to restore full functional capacity. In some cases a corticosteroid injection into the biceps tendon sheath to reduce persistent pain and inflammation may be advised. Education on posture and proper lifting technique is also important to prevent recurrence.
Surgical treatment
Surgical treatment for biceps tendinopathy is usually considered only when symptoms persist despite several months of conservative management or when there is significant tendon damage or associated shoulder pathology. The most common procedures are biceps tenotomy and biceps tenodesis, both typically performed arthroscopically. In a tenotomy, the long head of the biceps tendon is simply released from its attachment, which can quickly relieve pain but may sometimes lead to a visible “Popeye” deformity or mild loss of strength in some patients. In a tenodesis, the tendon is released from its original attachment and then reattached to the humerus, preserving more muscle function and reducing cosmetic deformity risk. Tenodesis is often preferred for younger or more active individuals. Surgery may also be combined with treatment of other shoulder problems, such as rotator cuff repair or decompression if they are contributing to symptoms. Following surgery, a structured rehabilitation program is essential to restore strength, mobility, and function.
Recovery
When can I return to daily activities?
This depends on the activity, the exact nature of your surgery and your progress with your rehabilitation.
Most people can:
- Return to office or light duties (no use of the arm at chest height or above, no repetitive duties, no heavy lifting) at 10-14 days. Sling should be worn when using a computer / doing admin work
- Walking for exercise from 3 weeks
- Driving – approximately 4-6 weeks, 15-30 minutes as you feel safe and confident. When you are no longer using the sling and have full control of the vehicle. No truck driving until 4 months
- No heavy lifting particularly above chest height for 6 months
When can I participate in leisure activities?
Your ability to start these will be dependent on the range of movement and strength that you have in your shoulder following the operation. Please discuss activities in which you may be interested with your physiotherapist or surgeon.
Start with short sessions, involving little effort and gradually increase. General examples are:
- Cycling – 4 to 6 weeks
- Jogging – 12 weeks
- Swimming – gentle breast-stroke 12 weeks, freestyle variable timeframe (minimum 4 months)
- Light sports/racquet sports using non-operated arm – 10 weeks
- Racquet sports using operated arm / Golf – 4 to 6 months
- Contact or collision sports which includes horse riding, soccer, martial arts, football and rock climbing – 6 to 9 months