Biceps Tendonitis: Symptoms, Treatment and Exercises

01What

What is biceps tendonitis?

The biceps muscle has two tendons at the shoulder: the short head, attached to the shoulder blade, and the long head, which runs in a groove at the front of the upper arm bone (the bicipital groove) and attaches inside the shoulder joint to the top of the socket (the glenoid labrum). “Biceps tendonitis” usually refers to irritation of the long head tendon. In many people it develops alongside rotator cuff tendinopathy, subacromial pain or shoulder instability rather than alone.

02Symptoms

Symptoms

• Deep aching pain at the front of the shoulder, sometimes radiating down the front of the arm.
• Pain with overhead reaching, lifting, pulling, throwing or pushing.
• Tenderness over the bicipital groove at the front of the shoulder.
• Pain at night, especially when lying on the affected side.
• Weakness or fatigue during repetitive tasks; sometimes a snapping or clicking feeling.
• Limited by pain rather than by true stiffness.

03Causes

Causes and risk factors

• Repetitive overhead activity (swimming, tennis, throwing, painting, construction).
• Heavy lifting or training with poor technique (curls, rows, bench press).
• Sudden increases in training load.
• Rotator cuff problems and shoulder instability, which overload the biceps tendon.
• Age-related tendon changes after 40.
• Weak scapular and rotator cuff muscles and poor posture.

04Look-alikes

Other conditions with similar pain

• Rotator cuff tendinopathy or tear: pain on the top and side of the shoulder and weakness lifting the arm. See shoulder tendinitis (Spanish) and supraspinatus exercises (Spanish).
• SLAP lesion (labral tear) in throwers and overhead athletes, with clicking and pain on throwing.
• Frozen shoulder: marked stiffness in all directions.
• Cervical spine problems referring pain to the shoulder.
• Biceps rupture: sudden pop, bruising and a bulge in the arm.
• A clinician can usually tell these apart by examination; ultrasound or MRI are used when unclear.

05Management

First steps

• Relative rest: reduce overhead lifting, pulling and throwing that provoke pain; do not immobilise the shoulder in a sling for long.
• Pain relief: paracetamol, short courses of anti-inflammatories if suitable, ice or heat for comfort.
• Keep the shoulder moving within pain limits to avoid stiffness.
• Adjust technique and workload: hold weights close to the body, avoid behind-the-neck presses and wide-grip movements.
• Sleep with a pillow supporting the arm; avoid lying on the sore side.

06Exercises

Graded exercise programme

• Phase 1 – settle pain: pendulum swings, isometric external rotation (arm at the side, press the back of the hand into a wall for 10–30 seconds), isometric elbow flexion.
• Phase 2 – build strength: external and internal rotations with a band (3 × 12), rows with band (3 × 12), scapular retraction, side-lying external rotation with light weight.
• Phase 3 – biceps and shoulder loading: slow elbow curls with a light dumbbell (3 × 10, 3 seconds down), prone Y-T-W raises, push-up plus, eccentric bicep curls.
• Phase 4 – return to function: overhead press with light weight, sport-specific drills, throwing or swimming progressions.
• Keep pain at 3–4/10 or less during exercise and make sure it settles within 24 hours. Most people need 6–12 weeks of consistent work. See also posterior deltoid exercises (Spanish).

07Medical

Other treatments

Physiotherapy provides assessment, manual therapy and a tailored exercise programme, which is the mainstay of treatment. Corticosteroid injections can give short-term relief in some people but are used cautiously. Surgery, such as biceps tenodesis or tenotomy, is considered rarely, for persistent pain despite months of rehabilitation or for associated problems like labral tears or rotator cuff tears.

08Prevention

Prevention

• Warm up before lifting, throwing or swimming.
• Build up training gradually and allow recovery between sessions.
• Strengthen the rotator cuff, shoulder blade and upper back muscles.
• Use proper technique when lifting and avoid prolonged overhead work without breaks.
• Maintain good posture and ergonomic setups.

10Cases

Three common situations

Gym user with front-of-shoulder pain after increasing curls and pull-ups: reduce volume, adjust technique and begin a graded programme.

Swimmer with pain on overhead strokes: reduce yardage, review technique and strengthen the cuff and scapular muscles.

Painter with night pain and weakness: check for rotator cuff involvement with a clinician.

11Summary

Key points to remember

Biceps tendonitis responds well to load management and graded exercise. Avoid provoking activities for a short time, keep the shoulder moving, strengthen the cuff and shoulder blade, and return to overhead activity progressively. Seek assessment if there is a pop, weakness, night pain or no improvement.

This guide is for general information and does not replace an assessment by your own doctor or physical therapist.