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What is biceps tendinopathy?


The biceps muscles are located in the front of the arm. They help flex the elbow, rotate the forearm, and move the shoulder.

Biceps tendon pathology can be classified into three categories:

  • Biceps tendonitis is acute inflammation of the tendon. This occurs after an injury or trauma.

  • Biceps tendon tears can occur after severe injuries.

  • Biceps tendinopathy is chronic overuse or overload of the tendon. This usually occurs after prolonged repetitive and overuse activities. Read more about tendinopathy here.


How does biceps tendinopathy occur?


Biceps tendonitis can occur after high impact activities that cause inflammation of the tendon. People with tendonitis can usually pinpoint a specific activity or injury that triggered the symptoms.


Biceps tendinopathy results from repeated stress of the biceps tendon. Those with biceps tendinopathy tend to have pain that gets worse over the course of days to weeks.


Biceps tendinopathy symptoms


The biceps tendon pain can manifest in two places. Proximal biceps tendon pain occurs in front of the shoulder. Distal biceps tendon pain occurs in front of the elbow.


Diagnosis of biceps tendinopathy


Biceps tendon dysfunction can be diagnosed with a thorough physical exam.


Proximal biceps pain can mimic shoulder pain. Movements of the shoulder or provocative testing of the shoulder reproduces pain. Strength testing of the shoulder can cause pain.


Distal biceps tendon pain is worse with movement of the elbow or rotation of the forearm. Strength testing of the elbow can cause pain.


X-rays may be necessary in the setting of injury or trauma to rule out fracture.

Ultrasound can look for inflammation and assess the integrity of the tendon.


Biceps tendinopathy treatment


Initial treatment involves resting and protecting the shoulder or elbow. Avoid or modify activities that exacerbate pain. Once pain improves, gradually increase physical activity.


Acute pain

  • Icing the area can help reduce pain and swelling. Apply ice 15-20 minutes at a time. Do this every 4 hours for the first two to three days or until pain improves.

  • Oral or topical anti-inflammatory medications can help decrease inflammation and control pain.


Supportive devices

  • A sling can be worn temporarily to provide support and comfort.


Persistent symptoms

  • Patients with persistent symptoms may need injections. This study showed platelet rich plasma injections can help tendon healing.


Biceps tendinopathy rehabilitation


The goal of rehabilitation is to return to activity as quickly and as safely as possible. Returning too soon can exacerbate symptoms. It can also weaken the tendon and lead to tendon tears.


A home exercise program will help improve range of motion, stability, and strength. Some people choose to participate in physical therapy. Physical therapists assess, guide, and teach you exercises and stretches. They also individualize a training program for you and your body.


Here is a link to a great example of a home exercise program for biceps tendinopathy:

Proximal biceps tendinopathy stretches and exercises

Distal biceps tendinopathy stretches and exercises


Try to do your home exercise program twice a day. When pain is severe, focus on stretching and range of motion. Include strengthening exercises as pain improves.


Recovery for biceps tendinopathy


Recovery is determined by the duration and severity of the injury. The longer you have symptoms, the longer it will take to get better. Use symptoms as a guide for progression. Avoid using time in days or weeks as a marker for recovery.


Decrease the frequency of your home exercise program as your symptoms improve. For example, if doing the exercises twice a day, decrease to once a day. Do this for about one week.


Many people choose to incorporate these exercises into their weekly workout routine. This can help prevent reinjury as well as maintain strength, mobility, and range of motion.


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Some pictures were taken without permission from the Sports Medicine Patient Advisor. They are intended for educational purposes only.