Evidence-based guidance for patients, athletes and clinicians
What is biceps tendinitis, and what is subluxation?
The long head of the biceps tendon (LHBT) runs from the top of the shoulder socket (glenoid) down the front of the arm.
- Tendinitis/tendinopathy: Pain caused by degenerative change within the tendon, not true inflammation.
- Subluxation: The tendon slips partly out of its bony groove; complete escape is called dislocation. Both conditions produce sharp anterior shoulder pain and clicking.
Why does it happen?
Mechanism | Typical setting | Key points |
Overuse & degeneration | Repetitive overhead sport (swimming, tennis, cricket, baseball) or manual work | Microscopic wear weakens the tendon; 97 % of ruptures show degenerative change, not inflammation. |
Pulley failure | Subscapularis or supraspinatus tear; injury to the coracohumeral / superior glenohumeral ligaments | The ‘biceps sling’ fails → tendon drifts medially. |
Impingement | Acromial spurs, thickened CA ligament | Tendon rubbed under the coraco-acromial arch. |
Trauma | Fall on outstretched arm, lesser-tuberosity fracture | Acute instability or rupture. |
3 Red-flag symptoms
- Deep ache or sharp pain at the front of the shoulder, worsened by overhead reach.
- Audible click / pop when rotating the arm.
- Night pain lying on the affected side.
- Local tenderness in the bicipital groove.
- Visible ‘Popeye’ bulge in the upper arm after rupture.
4 Examination pearls
- Speed’s test – pain with resisted forward flexion, elbow straight, palm up.
- Yergason’s test – pain or palpable slip with resisted supination.
- Upper-cut test – painful pop during a mock punch.
Always test the subscapularis (Lift-off, Belly-press) because its tear is the commonest cause of LHBT instability.
5 Imaging – when and why
Modality | Use | Strengths / limits |
Ultrasound | First-line in clinic | Dynamic view of tendon slip; operator dependent. |
MRI shoulder | Gold standard | Shows tendon position, pulley tears, cuff pathology. |
MR-arthrogram | Selected cases | Best for subtle pulley lesions or SLAP tears. |
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6 Treatment pathway
6.1 Conservative (first 6–8 weeks)
- Relative rest & ice in the acute phase.
- Oral NSAIDs for pain control (check gastro-renal risk).
- Physiotherapy – staged:
- Posture correction, scapular control.
- Gradual cuff and periscapular strengthening.
- Avoid loaded overhead work until pain-free.
- Ultrasound-guided steroid into the biceps sheath if pain limits rehab.
Success tip: Many cases settle with structured rehab; continued overload or poor posture is the usual reason for persistence.
6.2 Surgical (if conservative care fails or clear instability)
Procedure | Best for | Pros | Cons / risks |
Arthroscopic tenotomy | Older, low-demand patients; frayed tendon <50 % | Quick, reliable pain relief | Possible Popeye bulge; mild cramp in 10–20 % |
Arthroscopic or open tenodesis | Instability, athletes, cosmetic concern | Maintains length-tension; low Popeye rate; preserves strength | Longer rehab; groove pain if fixation too proximal |
Subpectoral tenodesis | Revision cases, groove pain | Removes tendon from groove entirely | Small risk of humeral fracture |
7 Rehabilitation milestones (tenodesis)
Phase | Focus | Typical duration* |
Immobilisation | Sling, hand-use only | 0–3 weeks |
Passive ROM | Pendulum, table slides | 3–6 weeks |
Active ROM | Elevation, ER/IR in scapular plane | 6–9 weeks |
Strength | Cuff, scapula and gradual elbow flexion/supination | 9–16 weeks |
Return to sport | Overhead skills, plyometrics | 4–6 months |
*Timings vary with surgeon protocol. |
Clinical Pearls / Key Points
- Over 90 % of symptomatic LHBT lesions co-exist with rotator-cuff or pulley injury – always look for combined pathology.
- Absence of the tendon in the bicipital groove on axial MRI is pathognomonic of dislocation.
- Tenodesis revision rates have fallen markedly with distal (subpectoral) fixation.
- Smoking and uncontrolled diabetes slow tendon healing – optimise before surgery.
Patient FAQs
Question | Plain-English answer |
Is “tendinitis” the same as inflammation? | Not usually. Most sore biceps tendons show wear-and-tear change, not classic inflammation. |
Will exercises make it worse? | Early gentle motion is safe. Heavy overhead weights should wait until pain has settled and strength rebuilt. |
What is a tenodesis? | The surgeon moves the tendon out of the joint and anchors it lower down the arm, keeping normal muscle length and strength. |
Will I lose strength after tenotomy? | Most people notice little difference in day-to-day tasks, but heavy supination (e.g. using a screwdriver) can feel weaker. |
Call to Action
If you have pain, book an appointment to be reviewed by Prof Imam or another member of our specialist team at The Arm Clinic. Early specialist care helps prevent long-term issues. Visit www.TheArmDoc.co.uk or book your consultation today. Phone: 020 3384 5588 | Email: Info@TheArmDoc.co.uk
Disclaimer
This information is for general educational purposes and should not be used as a substitute for professional medical advice. Consult a healthcare professional for individual guidance on your condition and treatment options.
This page was last clinically updated in May 2025