Biceps Tendinitis (Long Head)

Pain and dysfunction of the long head of biceps (LHB) tendon in the bicipital groove and intra-articular portion. Usually a tendinopathy, not true inflammation.

The key clinical fact

It is rarely isolated. More than 90% of cases have concurrent rotator cuff or subacromial pathology, and it can accompany a SLAP lesion (superior labrum tear at the LHB anchor). Treat the whole shoulder, not just the biceps.

Mechanism and risk

Repetitive overhead or throwing load within the groove
Cuff failure allows superior humeral migration, raising LHB load
Traction injury at the labral origin (SLAP): throwing deceleration, or fall on an outstretched abducted arm
Degeneration, most common at 40 to 60 years
Risk factors: overhead activity, cuff weakness (especially subscapularis tear), scapular dyskinesis, AC arthrosis, LHB variants, smoking
Sports: baseball, javelin, swimming, weightlifting, racquet sports

Presentation

Anterior shoulder pain localised to the groove, may radiate down the arm
Point tenderness over the bicipital groove, arm slightly internally rotated
Speed’s: resisted forward flexion, elbow extended, forearm supinated
Yergason’s: resisted supination, elbow at 90°
Ludington’s: resisted contraction with hands behind the head
SLAP clues: deep pain, catching or popping, positive O’Brien’s test. No single test is definitive.
“Popeye” deformity: suggests LHB rupture, often with a subscapularis tear.

Management

Conservative first. Most cases improve without surgery.
Load management and progressive strengthening of biceps, cuff and scapular stabilisers. Treating the concurrent pathology improves biceps symptoms.
NSAIDs: symptomatic only.
Corticosteroid injection: into the tendon sheath for short-term relief. Never intratendinous (rupture risk).
Surgery: confirmed SLAP lesions or LHB tears failing conservative care, or when concomitant pathology needs surgery.

Procedure	Trade-off
Tenotomy	Simpler, faster recovery, possible Popeye deformity
Tenodesis	Preserves contour and strength. Preferred in younger, active patients

Isolated SLAP repair has fallen out of favour compared with tenodesis, which shows more reliable outcomes.

References

Long head of biceps tendinopathy, J Am Acad Orthop Surg 2010, doi:10.5435/00124635-201011000-00002
Long head of biceps scoping review, BMC Musculoskelet Disord 2023, doi:10.1186/s12891-023-06346-5

Medical disclaimer: this article is general information, not personal medical advice. Always consult a qualified doctor about your own situation.