Long Head Biceps Tendonitis
What Is the Anatomy of the Long Head Biceps Tendon?
The biceps muscle has two tendons that attach at the shoulder: the short head and the long head. The long head biceps tendon originates from the top of the glenoid (shoulder socket) and the superior labrum within the shoulder joint. It travels through the shoulder joint and exits via the bicipital groove on the humerus (upper arm bone). The biomechanical role of the long head biceps tendon is controversial, as there is no consensus on whether it provides stability or functional strength to the shoulder.
How Does Long Head Biceps Tendonitis Occur?
Long head biceps tendonitis occurs when the tendon becomes inflamed or irritated, usually due to overuse or repetitive shoulder motion. Common causes include:
Repetitive overhead activities such as throwing, swimming, or weightlifting.
Shoulder impingement or friction from nearby bone spurs.
Degeneration of the tendon associated with ageing or chronic rotator cuff tears.
Shoulder instability or labral tears that place excessive stress on the tendon.
Over time, this leads to inflammation, pain, and sometimes partial tearing of the tendon.
What Is the Long-Term Consequence of Having Long Head Biceps Tendonitis?
If left untreated, long head biceps tendonitis can progress to:
Persistent shoulder pain, particularly at the front of the shoulder.
Partial or complete rupture of the tendon, leading to a visible bulge in the arm (known as a “Popeye” deformity).
How Does Long Head Biceps Tendonitis Get Diagnosed?
Diagnosis is based on a combination of clinical history, examination, and imaging:
History of anterior shoulder pain that worsens with overhead activity or lifting.
Physical examination revealing tenderness over the bicipital groove and pain with biceps-focused tests.
MRI can confirm inflammation, fraying, or partial tearing of the tendon and assess for associated shoulder pathology such as rotator cuff tears.
X-rays are obtained to evaluate for any degenerative changes or bone abnormalities in the shoulder.
What Are the Indications for Treating Long Head Biceps Tendonitis Non-Operatively?
Non-operative treatment is recommended in most cases and includes:
Mild to moderate symptoms.
Patients willing to modify activities and participate in physiotherapy.
Treatment focuses on rest from aggravating activities, physiotherapy to strengthen the rotator cuff and shoulder stabilisers, and anti-inflammatory medication. Corticosteroid injections into the bicipital groove may be used to reduce inflammation and pain.
What Are the Indications for Treating Long Head Biceps Tendonitis Operatively?
Surgical treatment may be indicated when:
Symptoms persist despite at least 3–6 months of non-operative management.
Associated shoulder pathology (such as rotator cuff tears or labral injuries) requires surgical correction.
Surgical options include biceps tenotomy (releasing the tendon from its attachment) or biceps tenodesis (re-attaching the tendon to the upper arm bone). The choice of procedure depends on the patient’s age, activity level, and the quality of the tendon.
