Biceps tendonitis is an inflammatory process of the long
head tendon and is a common cause of shoulder pain due to its
position and function. The tendon is exposed on the anterior
shoulder as it passes through the humeral bicipital groove and
inserts on the superior aspect of the labrum of the glenohumeral
Radiology of the shoulder including a plane film
projection of the biciptal groove may show roughness of the groove,
however radiology is often normal.
The biceps muscle is not a primary mover of the shoulder but is
affected by shoulder movement. The tendon of the long head glides
smoothly in the bicipital groove during shoulder motion. The long
head of the biceps originates above the glenoid and passes out of
the shoulder joint to continue distally down the arm. As it exits
the shoulder, it is in close approximation to the rotator cuff.
Thus, any process that can irritate the anterior-superior rotator
cuff (especially so-called "impingement" syndrome) can likewise
involve the biceps. The tendon may also subluxate out of its groove
in the proximal humerus, causing pain and irritation.
Tendonitis of long head of the biceps may be an isolated phenomenon
or a component of another process affecting other structures in the
shoulder. One precipitating factor is repetitive use, such as the
motion involved in throwing a ball repeatedly. It also may coexist
with unrelated disease of nearby anatomy, such as the
acromioclavicular joint. Detailed shoulder is examination required
to rule out concomitant disorders, such as calcium salt deposits,
fibrosis, fraying, and degenerative changes.
Only refractory cases of biceps tendonitis require referral to an
orthopedic surgeon. Many patients will achieve a good result without
surgery. The presence of co-existing pathology such as arthritis or
cuff tears may demand the attention of a surgeon.
Diagram of the Anatomy involved in Bicipital Tendonitis