Tendonitis of the Long Head of the Biceps by AAOS

Long head of biceps tendonitis is an inflammation or irritation of the upper biceps tendon. This strong, cord-like structure connects the upper end of the biceps muscle to the bones in the shoulder.

Pain in the front of the shoulder and weakness are common symptoms of biceps tendonitis. They can often be relieved with rest and medication. In some cases, surgery is necessary to repair the tendon.

Anatomy
Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps your arm centered in your shoulder socket. These tissues are called the rotator cuff. They cover the head of your upper arm bone and attach it to your shoulder blade.

The biceps muscle is in the front of your upper arm. It helps you bend your elbow and rotate your arm. It also helps keep your shoulder stable.

The biceps muscle has two tendons that attach it to bones in the shoulder. The long head attaches to the top of the shoulder socket (glenoid). The glenoid is lined with soft cartilage called the labrum. This tissue helps the head of the upper arm fit into the shoulder socket.

The short head of the biceps tendon attaches to a bump on the shoulder blade called the coracoid process.

Description
Biceps tendonitis is inflammation of the long head of the biceps tendon.

Biceps tendonitis usually occurs along with other shoulder problems. In most cases, there is also damage to the rotator cuff tendon. Other problems that often accompany biceps tendonitis include:
• Arthritis of the shoulder joint
• Tears in the glenoid labrum
• Chronic shoulder instability
• Shoulder impingement
• Other diseases that cause inflammation of the shoulder joint lining

In the early stages of biceps tendonitis, the tendon becomes red and swollen. As tendonitis develops, the tendon sheath (covering) can thicken. The tendon itself often thickens or grows larger.

The tendon in these late stages is often dark red in color due to the inflammation. Occasionally, the damage to the tendon can result in a tendon tear, and then deformity of the arm (a "Popeye" bulge in the upper arm).

Cause
In most cases, damage to the biceps tendon is due to a lifetime of overhead activities. As we age, our tendons slowly weaken with everyday wear and tear. This degeneration can be worsened by overuse — repeating the same shoulder motions again and again.

Swimming, tennis, and baseball are some sports examples of repetitive overhead activities. Many jobs and routine chores can cause overuse damage as well.

Repetitive overhead motion plays a part in other shoulder problems that occur with biceps tendonitis. Rotator cuff tears, osteoarthritis, and chronic shoulder instability are often caused by overuse.

Symptoms
Pain or tenderness in the front of the shoulder, which worsens with overhead lifting or activity

Pain or achiness that moves down the upper arm bone

An occasional snapping sound or sensation in the shoulder

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