Caroline Unger, MSPT, CSCS, EMT. Caroline is a Physical
Therapist at Genesis ElderCare in Manahawkin NJ. She received
her undergrad degree at Rutgers University and her Masters degree
at the University of Miami.
The biceps muscle is situated in the front of the upper arm.
The larger section of the biceps, called the long head, is attached
to the glenoid fossa of the shoulder by a long tendon. This
tendon passes through a groove in the upper arm known as the bicipital
groove. This is the area, as the groove slides on the tendon,
where tendinitis strikes. In most situations, the injury will
cause anterior shoulder pain.
How does it Happen?
Very often biceps tendinitis is seen as an overuse-type injury caused
by excessive overhead motions (throwing, swimming, spiking, etc.).
In this situation the injury is due to excessive wear on the tendon,
but other factors can contribute to the problem. The biceps
tendon is normally held in its groove by the transverse humeral ligament.
If the ligament is injured or stretched the biceps tendon will abnormally
slide and cause an irritation. The bicipital groove itself may
be deformed. If it is too shallow or has rough edges it can
also cause an irritation along the tendon.
Biceps tendinitis commonly occurs with other shoulder diagnoses.
This is because the subacrominal space - area just below the lateral
tip of the shoulder - houses many important structures in a very small
area. The biceps tendon is located in the subacromial space
along with the rotator cuff tendons and a bursa sac. The slightest
bit of inflammation will cause an irritation to any or all of these
Part of the treatment includes controlling the inflammation.
In severe cases a doctor may recommend a cortisone injection or oral
anti-inflammatory medication. Icing the area following strenuous
activity, at the end of the day, and more often if able will be very
beneficial. A bag of frozen vegetables will do nicely if
ice or an ice bag is not available. Strengthening of
long head of the biceps, rotator cuff, scapular muscles, and shoulder
proprioception may be needed. If rehabilitation has been recommended
by a doctor, the physical therapist or athletic trainer may choose
different modalities such as electrical stimulation, ultrasound, or
iontophoresis to address pain relief as well as control inflammatory
process. Time off from the aggravating activity is also usually
If the athlete is only having minor pain with activity they normally
can participate as tolerated while beginning ice treatments and rehab.
If the injury progresses to pain during and after activity the athlete
can usually participate but requires rehabilitation and days off from
the injury causing motion. The athlete that reaches the stage
of pain before, during, and after activity, warrants referral to an
orthopedist before regular overhead activities are permitted.