Biceps tendinopathy
Biceps tendinopathy is inflammation and degeneration of the long head of the biceps tendon in the bicipital groove, causing anterior shoulder pain aggravated by lifting, carrying, and overhead work. It is a clinical diagnosis made from bicipital groove tenderness with a positive Speed or Yergason test and preserved passive motion, treated with rest, activity modification, NSAIDs, and physical therapy, with an ultrasound-guided tendon sheath glucocorticoid injection for persistent or severe pain.
- Topic reviewThe full article, organized the way the exam asks it.
- ABIM-format MCQsVignettes with an explanation for every wrong answer.
- Key factsThe numbers and thresholds worth memorizing, up front.
- AI tutorMedBrain answers the question you're stuck on.
What this article covers
- Overview
Definition: biceps tendinopathy (bicipital tendinitis) is inflammation and degeneration of the long head of the biceps tendon within the bicipital groove, most often from overuse or chronic tendon subluxation.
- Epidemiology
A less common cause of shoulder pain than rotator cuff disease, which is the most common cause of shoulder pain overall and produces the more common anterolateral pain pattern.
- Risk factors
Overuse from repetitive lifting and carrying: the leading cause, loading the long head of the biceps tendon as it glides in the bicipital groove.
- Pathophysiology
Anatomy sets the lesion: the long head of the biceps courses intra-articularly but extrasynovially, runs through the bicipital groove, and attaches to the superior labrum, where it contributes to shoulder stability.
- Clinical features
Anterior shoulder pain over the bicipital groove, aggravated by lifting, carrying, and overhead activity and radiating toward the deltoid or down into the biceps: this pattern, with the exam findings…
- Differential diagnosis
Rotator cuff tear: anterolateral pain with weakness in external rotation or abduction and a positive drop-arm test, whereas cuff strength is normal in biceps tendinopathy; see rotator-cuff-syndrome.
- Diagnosis
Biceps tendinopathy is a clinical diagnosis established by anterior shoulder pain with bicipital groove tenderness and pain reproduced in the groove by the Speed or Yergason test, with full passive…
- Management
First, start conservative therapy for every patient: rest and activity modification (stop the provoking lifting, carrying, and overhead work) combined with an NSAID.
- Complications
Tendon rupture: a degenerated tendon can rupture with forceful flexion, producing sudden pain, an audible pop, and the Popeye deformity.
- Prognosis
Most patients improve with conservative care: rest, activity modification, NSAIDs, and physical therapy resolve the majority, with physical therapy, injection, and surgery reserved for refractory cases.
- Prevention
Modify load in workers and athletes who lift, carry, or work overhead, reducing repetitive loaded shoulder flexion before pain becomes persistent.
Read the whole article
Subscribing to Internal Medicine opens every article, the full question bank and MedBrain, on the web, iPhone and Android.
Related articles
- Rotator cuff syndrome
Rotator cuff syndrome spans subacromial impingement, tendinopathy, and full-thickness tear of the supraspinatus and its neighboring tendons, presenting with lateral shoulder pain worse with overhead activity and at night. Impingement is managed with activity modification, NSAIDs, physical therapy, and corticosteroid injection, while a confirmed full-thickness tear with weakness or failed conservative therapy is referred for surgical repair.
- Adhesive capsulitis
Adhesive capsulitis (frozen shoulder) is progressive fibrotic thickening of the glenohumeral joint capsule causing global loss of active and passive range of motion. It is a clinical diagnosis treated with range-of-motion physical therapy, analgesia, and intra-articular glucocorticoid injection, with capsular release reserved for cases that fail 3 to 6 months of conservative care.
- Bursitis
Bursitis is inflammation of a synovial bursa, most often the olecranon or prepatellar bursa, and the first task is distinguishing aseptic (traumatic or crystal) bursitis from septic bursitis before treating.
- Shoulder dislocations
Shoulder dislocation is displacement of the humeral head from the glenoid, most often anterior after a fall or load-bearing injury with the arm held abducted and externally rotated, or posterior after a seizure or electrical injury with the arm adducted and internally rotated. Diagnosis is clinical, confirmed by radiograph, and treatment is prompt closed reduction followed by a sling, with surgery reserved for recurrent instability or an associated fracture.
- Cervical radiculopathy
Cervical nerve root compression from disk herniation or degenerative spondylosis causes neck pain with dermatomal arm pain, paresthesia, weakness, and reduced reflexes, diagnosed clinically with the Spurling test and treated conservatively with NSAIDs and exercise before imaging or surgery.
- Polymyalgia rheumatica
Polymyalgia rheumatica (PMR) is an inflammatory disorder of older adults causing aching and prolonged morning stiffness of the shoulder and hip girdles with elevated inflammatory markers, but without true weakness and with a normal creatine kinase. It is a clinical diagnosis, and treatment begins with prednisone 12.5 to 25 mg/day, which produces a dramatic response within days.
- Osteoarthritis
Osteoarthritis is a chronic progressive joint disorder of cartilage and subchondral bone degradation with low-grade synovitis, diagnosed clinically from age, activity-related pain, and exam findings, and managed with exercise, weight loss, topical or oral NSAIDs, and joint replacement for refractory disease.