Return to Play

Return to activity should not occur until the patient's discomfort and pain is controlled effectively and a monitoring program has been initiated. Some authors recommend waiting 3 weeks after pain has completely resolved before allowing participation in competitive activities.

Complications

Individuals who return to a high level of athletic activity too soon may find themselves with symptom flare-ups. Continued straining of an injury that has not healed completely can put the individual at risk for chronic degenerative tissue damage and biceps tendon rupture.

Prevention

Prevention of bicipital tendinitis is similar to prevention of rotator cuff injuries, including warm-ups before exercise, the use of passive stretching and strengthening exercises, avoidance of painful activities, and the use of proper biomechanics. Increased attention should be made for those athletes at high risk of bicipital tendinitis, such as baseball pitchers. High angular velocity and torques combined with the repetitious nature of pitching results in vulnerability of the shoulder to injury.

Prognosis

Although the prognosis of bicipital tendinitis is dependent upon the degree of injury, most patients do well with treatment (see Treatment: Acute Phase, Recovery Phase, Maintenance Phase, and Surgical Intervention). However, a significant number of patients develop degenerative changes, and spontaneous rupture of the biceps tendon occurs in 10% of patients.

Education

Inform the patient that an increased risk of biceps tendon rupture or chronic inflammatory changes exists if the directed restrictions are not followed.

Questions

Ahrens PM, Boileau P. The long head of biceps and associated tendinopathy. J Bone Joint Surg Br. 2007 Aug. 89(8):1001-9. [QxMD MEDLINE Link].
Safran MR, McKaeg DB, Van Camp SP, eds. Biceps tendon injuries. Manual of Sports Medicine. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998. 347-9.
Nicholis JA, Hershman EB, eds. Bicipital tendinitis. The Upper Extremity in Sports Medicine. 2nd ed. St. Louis, Mo: Mosby; 1995. 303-6.
Rockwood CA Jr, Matsen FA II, eds. The Shoulder. Philadelphia, Pa: WB Saunders; 1990. 810-21.
Murtagh J. Bicipital tendinitis. Aust Fam Physician. 1991 Jun. 20(6):817. [QxMD MEDLINE Link].
Singaraju VM, Kang RW, Yanke AB, McNickle AG, Lewis PB, Wang VM, et al. Biceps tendinitis in chronic rotator cuff tears: a histologic perspective. J Shoulder Elbow Surg. 2008 Nov-Dec. 17(6):898-904. [QxMD MEDLINE Link].
Patton WC, McCluskey GM 3rd. Biceps tendinitis and subluxation. Clin Sports Med. 2001 Jul. 20(3):505-29. [QxMD MEDLINE Link].
Ellenbecker TS. Rehabilitation of shoulder and elbow injuries in tennis players. Clin Sports Med. 1995 Jan. 14(1):87-110. [QxMD MEDLINE Link].
Ouellette H, Labis J, Bredella M, et al. Spectrum of shoulder injuries in the baseball pitcher. Skeletal Radiol. 2007 Oct 3. Epub ahead of print. [QxMD MEDLINE Link].
Park SS, Loebenberg ML, Rokito AS, Zuckerman JD. The shoulder in baseball pitching: biomechanics and related injuries -- part 1. Bull Hosp Jt Dis. 2002-2003. 61(1-2):68-79. [QxMD MEDLINE Link]. [Full Text].
Hadala M, Barrios C. Sports injuries in an America's Cup yachting crew: A 4-year epidemiological study covering the 2007 challenge. J Sports Sci. 2009 May. 27(7):711-7. [QxMD MEDLINE Link].
Kim KC, Rhee KJ, Shin HD, Kim YM. A SLAP lesion associated with calcific tendinitis of the long head of the biceps brachii at its origin. Knee Surg Sports Traumatol Arthrosc. 2007 Dec. 15(12):1478-81. [QxMD MEDLINE Link].
Churgay CA. Diagnosis and treatment of biceps tendinitis and tendinosis. Am Fam Physician. 2009 Sep 1. 80(5):470-6. [QxMD MEDLINE Link].
Onga T, Yamamoto T, Akisue T, Marui T, Kurosaka M. Biceps tendinitis caused by an osteochondroma in the bicipital groove: a rare cause of shoulder pain in a baseball player. Clin Orthop Relat Res. 2005 Feb. 431:241-4. [QxMD MEDLINE Link].
Streit JJ, Shishani Y, Rodgers M, Gobezie R. Tendinopathy of the long head of the biceps tendon: histopathologic analysis of the extra-articular biceps tendon and tenosynovium. Open Access J Sports Med. 2015. 6:63-70. [QxMD MEDLINE Link].
Gaskin CM, Anderson MW, Choudhri A, Diduch DR. Focal partial tears of the long head of the biceps brachii tendon at the entrance to the bicipital groove: MR imaging findings, surgical correlation, and clinical significance. Skeletal Radiol. 2009 Oct. 38(10):959-65. [QxMD MEDLINE Link].
Buck FM, Grehn H, Hilbe M, et al. Degeneration of the long biceps tendon: comparison of MRI with gross anatomy and histology. AJR Am J Roentgenol. 2009 Nov. 193(5):1367-75. [QxMD MEDLINE Link].
Carr RM, Shishani Y, Gobezie R. How Accurate Are We in Detecting Biceps Tendinopathy?. Clin Sports Med. 2016 Jan. 35 (1):47-55. [QxMD MEDLINE Link].
Rol M, Favard L, Berhouet J. Diagnosis of long head of biceps tendinopathy in rotator cuff tear patients: correlation of imaging and arthroscopy data. Int Orthop. 2017 Aug 25. [QxMD MEDLINE Link].
Papatheodorou A, Ellinas P, Takis F, et al. US of the shoulder: rotator cuff and non-rotator cuff disorders. Radiographics. 2006 Jan-Feb. 26(1):e23. [QxMD MEDLINE Link]. [Full Text].
Lecoq B, Levasseur R, Fournier L, Schmutz G, Marcelli C. Atypical pattern of acute severe shoulder pain: contribution of sonography. Joint Bone Spine. 2004 Nov. 71(6):592-4. [QxMD MEDLINE Link].
Ardic F, Kahraman Y, Kacar M, et al. Shoulder impingement syndrome: relationships between clinical, functional, and radiologic findings. Am J Phys Med Rehabil. 2006 Jan. 85(1):53-60. [QxMD MEDLINE Link].
Rees JD, Wilson AM, Wolman RL. Current concepts in the management of tendon disorders. Rheumatology (Oxford). 2006 May. 45(5):508-21. [QxMD MEDLINE Link]. [Full Text].
Ellman H, Gartsman GM. Arthroscopic Shoulder Surgery and Related Procedures. Philadelphia, Pa: Lea & Febiger; 1993. 243-4.
Skedros JG, Hunt KJ, Pitts TC. Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians. BMC Musculoskelet Disord. 2007 Jul 6. 8:63. [QxMD MEDLINE Link]. [Full Text].
Mitra R, Nguyen A, Stevens KJ. Fluoroscopically guided supraglenoid tubercle steroid injections for the management of biceps tendonitis. Pain Pract. 2011 Jul-Aug. 11(4):392-6. [QxMD MEDLINE Link].
Sethi N, Wright R, Yamaguchi K. Disorders of the long head of the biceps tendon. J Shoulder Elbow Surg. 1999 Nov-Dec. 8(6):644-54. [QxMD MEDLINE Link].
Scully WF, Wilson DJ, Grassbaugh JA, Branstetter JG, Marchant BG, Arrington ED. A simple surgical technique for subpectoral biceps tenodesis using a double-loaded suture anchor. Arthrosc Tech. 2013 May. 2(2):e191-6. [QxMD MEDLINE Link]. [Full Text].
Friedman DJ, Dunn JC, Higgins LD, Warner JJ. Proximal biceps tendon: injuries and management. Sports Med Arthrosc. 2008 Sep. 16(3):162-9. [QxMD MEDLINE Link].
Holtby R, Razmjou H. Accuracy of the Speed's and Yergason's tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Arthroscopy. 2004 Mar. 20(3):231-6. [QxMD MEDLINE Link].
Shah RR, Haghpanah S, Elovic EP, Flanagan SR, Behnegar A, Nguyen V, et al. MRI findings in the painful poststroke shoulder. Stroke. 2008 Jun. 39(6):1808-13. [QxMD MEDLINE Link]. [Full Text].
van Tulder M, Malmivaara A, Koes B. Repetitive strain injury. Lancet. 2007 May 26. 369(9575):1815-22. [QxMD MEDLINE Link].
Varacallo M, Mair SD. Bicipital Tendonitis. 2018 Jan. [QxMD MEDLINE Link]. [Full Text].
McDevitt AW, Snodgrass SJ, Cleland JA, Leibold MBR, Krause LA, Mintken PE. Treatment of individuals with chronic bicipital tendinopathy using dry needling, eccentric-concentric exercise and stretching; a case series. Physiother Theory Pract. 2018 Jun 22. 1-11. [QxMD MEDLINE Link].

Media Gallery

Biceps muscle and tendons.

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Author

Britt A Durham, MD Director of Risk Management, Department of Emergency Medicine, Martin Luther King Medical and Trauma Center, King-Drew Medical Center; Assistant Professor of Emergency Medicine, Drew College of Medicine; Assistant Clinical Professor of Emergency Medicine, UCLA School of Medicine; Partner and Chief Financial Officer, Durcress Medical Group, California Medical Board District Medical Consultant, Lakewood Atheletic Sports Medicine Team Physician

Britt A Durham, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Richard Chambers, MD Chief of Orthopedic, Diabetes and Amputee Service, Clinical Associate Professor, Department of Orthopedic Surgery, Rancho Los Amigos Medical Center, University of Southern California

Richard Chambers, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Diabetes Association, American Orthopaedic Foot and Ankle Society, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

David T Bernhardt, MD Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics/Ortho and Rehab, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health

David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.