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What is Biceps Tendinitis? Symptoms and Surgery

biceps tendinitis

Biceps tendinitis is a condition characterized by pain felt in the front of the shoulder. It is especially associated with tears of the subscapular tendon, one of the rotator cuff tendons of the shoulder, and shoulder impingement syndrome.

Pain in the front of the shoulder and weakness in the arm are the most common findings of biceps tendinitis. Although it usually responds to rest and medication, in some cases cortisol injection under ultrasound may be required.

In case of persistent pain, Biceps Tendinitis Surgery, which can be performed with closed shoulder surgery, that is, shoulder arthroscopy, is inevitable.

What is Biceps Tendinitis?

What is Biceps Tendinitis?

Biceps tendinitis occurs where the long head of the biceps tendon begins to enter the shoulder joint or is located within the shoulder joint. In particular, the term Biceps tendinitis is a general term and changes in the biceps tendon may occur over time in the following order;

  • Inflammation in the biceps tendon itself and -or its sheath.

  • Irritation in the biceps tendon.

  • Partial tears in the biceps tendon.

  • The biceps tendon exits and enters the groove where it passes through the front of the shoulder.

  • Biceps tendon rupture.

Biceps  Tendinitis  Why Does It Happen ?

Biceps tendinitis often occurs together with other diseases of the shoulder. These;

  • shoulder impingement syndrome

  • Rotator cuff tears (especially subscapular tendon tears)

  • Narrowing of the bicipital groove.

In most cases, damage to the biceps tendon results from normal activities. As we get older, the tendons in our body wear out during normal daily life activities, gradually weaken, and their healing capacity decreases.

This deterioration, which we also call tendon degeneration, can be worsened by excessive use.

Many movements we make in daily life, such as bringing our arms above our heads, can cause overuse damage to the biceps tendon.

Sports activities—especially activities that require repetitive overhead movements, such as swimming, tennis, basketball, and volleyball—put you at risk for biceps tendinitis.

What are the Symptoms of Biceps Tendinitis?

In biceps tendinitis, pain in the front part of the shoulder is often at the forefront. Sometimes patients can feel the tendon coming out of its groove.

  • Pain or tenderness in the front of the shoulder that worsens with overhead lifting or movement

  • Pain radiating from the front and/or side of the shoulder down to the elbow.

  • A crackling sound or cracking sensation in the shoulder during some movements, and sudden pain occurs and the pain disappears immediately.

These symptoms are signs that suggest the presence of Biceps Tendinitis . However, for definitive diagnosis and treatment, you can contact us on the contact page  .

How to Diagnose Biceps Tendinitis?

Biceps tendinitis can be diagnosed with shoulder ultrasound after shoulder examination. If another problem is suspected during the examination, MRI of the shoulder may be required.

In addition, conditions such as rotator cuff tendon tear   and shoulder impingement syndrome  , which frequently accompany biceps tendinitis, are detected with MRI imaging.

How to Treat Biceps Tendonitis?

If there is no problem with the integrity of the biceps tendon, if it does not enter and exit from the biceps groove (bicipital sulcus), in other words, if there is no mechanical problem; It would be appropriate to start the treatment of biceps tendinitis with the simplest treatment.

Biceps Tendinitis Non-Surgical Treatment

For those who have biceps tendinitis problems and are hesitant about surgery, treatment options that do not require surgery include the following:


The first step towards recovery is to avoid activities that cause pain.

cold application

To reduce swelling and pain, you can apply ice for 20-30 minutes several times a day, take a break for 1 hour, and then apply ice again for 20-30 minutes. Also, do not apply ice directly to the skin, as ice burns may occur on your skin. To prevent this, place a tissue or piece of cloth between the ice pack and your skin.


Using painkillers in consultation with your doctor can reduce inflammation in the tendon sheath.

Cortisol injection into the tendon sheath under ultrasound:

Steroids such as cortisol are very effective painkillers and anti-edema drugs. Injecting cortisol into the sheath of the tendon can relieve pain. Using ultrasound during this procedure increases the effectiveness of the treatment.


Physical therapy is an effective method for treating biceps tendinitis. Physiotherapists apply special exercise programs and manual therapy techniques to increase the patient's range of motion and muscle strength.

These exercises can help heal the biceps tendon by improving shoulder and elbow stabilization.

Treatment of increased fluid around the biceps tendon

Increasing fluid around the biceps tendon is a treatment option that helps reduce inflammation in the area and relieve pain.

During this procedure, your doctor injects anti-inflammatory medications, such as corticosteroids or PRP, into the bursa or joint space around the biceps tendon through a needle.

This treatment often helps relieve pain and increase the patient's functional level.

Biceps Tendinitis Surgery

Generally, non-surgical methods are tried for 3 months. If it is not successful, the decision for surgery is taken. In other words, if biceps tendonitis does not improve with non-surgical treatments, biceps tendinitis is treated with shoulder artoscopy surgery, which is performed with a camera and can only be done with 2-3 1 cm incisions. 

If there are other shoulder problems such as tendon tears in the shoulder or shoulder impingement syndrome, biceps tendinitis is difficult to respond to non-surgical methods. In such cases, it would be better to decide on surgery without wasting time.

It passes through a groove-like structure in an area close to the shoulder joint of the biceps tendon. This is called the bicipital sulcus. Stenosis in this groove may cause damage to the biceps tendon.

If the cause of biceps tendonitis is problems in this groove, it is unlikely that a response will be obtained from non-surgical methods. If such a situation is detected, surgery should be planned immediately.

Biceps tendinitis surgery is performed arthroscopically. During arthroscopy, he inserts a small camera called an arthroscope into your shoulder joint. While images are provided with this camera, procedures are performed with miniature surgical instruments.

What Surgeries Are Performed in Biceps Tendonitis?

There are basically two types of biceps tendon surgery. Both surgeries can be performed closed. These two surgeries are:

  1. Biceps tenodesis surgery

  2. Biceps tenotomy surgery

How is Biceps Tenodesis Surgery Performed?

During shoulder arthroscopy, the biceps tendon is examined. If the tendon is damaged, thinned and it is thought that it will continue to cause pain if the tendon is not intervened, biceps tenodesis surgery is performed.

In surgery, the damaged part of the biceps tendon is removed or cut from the damaged part. The remaining tendon is attached to the upper arm bone (humerus) with screws with ropes at the end.

This surgery is called biceps tenodesis surgery. Removing the painful part of the biceps relieves pain caused by the biceps.

Since the tendon is connected to the bone, it continues to perform its normal function. There is almost no loss of power. This biceps tenodesis surgery is especially preferred for athletes and patients under the age of 60.

biceps tendon pain

In the image you see the Biceps Tenodesis Surgery: the biceps tendon is cut and reattached to the upper arm bone.

How is Biceps Tenotomy Surgery Performed?

Another surgery performed in the treatment of biceps tendon problems is biceps tenotomy surgery.

In this surgery, the tendon is cut from the problematic area, but it is not attached to the bone as in tenodesis surgery. It is literally cut and left. Contrary to popular belief, it does not cause a serious decrease in arm strength.

After biceps tenotomy surgery, in some patients the biceps muscle may gather in the arm in the shape of an egg and cause cosmetic problems. This condition is called Popeye bicep (pop-eye deformity).

Can Biceps Tendinitis Be Cured with Physical Therapy?

It is possible to get rid of biceps tendonitis permanently, especially with manual therapy and an appropriate exercise program applied by an experienced physiotherapist.

If pain occurs when the intensity of the exercises is increased or when the tendon begins to be loaded, a cortisol injection under ultrasound guidance will facilitate physiotherapy and accelerate recovery.

Biceps Tendinitis Exercises  -  Which Exercises Are Good?

It is ideal to do the following exercises with the help of a physiotherapist. However, you can do it on your own, you should be careful that there is no pain while doing the exercises.

  • biceps curls

  • biceps stretching

  • Shoulder flexion

  • Shoulder internal rotation

  • Shoulder external rotation

  • These are forearm supination and pronation exercises.


Biceps tendinitis ; It is one of the most common causes of shoulder pain that significantly affects the quality of daily life of individuals. Biceps tendinitis is often associated with another problem in the shoulder joint.

While the diagnosis of biceps tendinitis is made meticulously, if there are other problems in the shoulder, it is important to know what these problems are in deciding on the treatment of biceps tendinitis.

Pain caused by biceps tendinitis can be relieved with early diagnosis and appropriate non-surgical interventions. However, if the condition is advanced, surgical intervention may also be required.

If the treatment of biceps tendinitis is planned as surgery , Op. Dr. You can decide together with Utku Erdem Özer  .

Thanks for reading my article. If you wish, you can browse the home page of from the link  .


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