Bicipital 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 joint. Disorders can result from
impingement or as an isolated inflammatory injury. Other causes are secondary to
compensation to rotator cuff disorders, labral tears, and intra-articular pathology.
Diagnosis of Bicipital Tendonitis
Local tenderness usually is present over the bicipital groove, which typically is
located 3 inches below the anterior acromion and may be localized best with the arm in
10° of external rotation.
Flexion of the elbow against resistance aggravates pain.
Passive abduction of the arm in a painful arc maneuver typical of impingement syndrome
may elicit pain; however, this finding may be negative in isolated biceps tendonitis.
Speed test: Patient complains of anterior shoulder pain with flexion of the shoulder
against resistance, while the elbow is extended and the forearm is supinated.
Yergason test: The patient complains of pain and tenderness over the bicipital groove
with forearm supination against resistance with the elbow flexed and the shoulder in
adduction. Popping of subluxation of the tendon may be demonstrated with this maneuver.
The remainder of the examination should be to document active and passive range of
motion (ROM) and joint stability in order to assess the rotator cuff and glenoid labrum. A
complete evaluation includes a complete neurovascular assessment as well.
Biceps tendonitis with labral tears or rotator cuff tears may not improve if all the
diagnoses are not treated.
Causes of Bicipital Tendonitis
The long head tendon passes down the bicipital groove in a fibrous sheath between the
subscapularis and supraspinatus tendons. This relationship causes the tendon to undergo
degenerative and attritional changes associated with rotator cuff disease because it
shares the associated inflammatory process within the suprahumeral joint.
Full humeral head abduction places the attachment area of the rotator cuff and biceps
tendon under the acromion. External rotation of the humerus at or above the horizontal
level compresses these suprahumeral structures into the anterior acromion. Repeated
irritation leads to inflammation, edema, microscopic tearing, and degenerative changes.
In younger athletes, relative instability due to hyperlaxity may cause similar
inflammatory changes on the bicipital tendon due to excessive motion of the humeral head.
Labral tears may disrupt the biceps anchor, resulting in dysfunction causing pain.
Other diagnostic considerations: The transverse humeral ligament holds the biceps
tendon long head within the bicipital groove. Injuries and disruption of the ligament can
lead to subluxation and medial dislocation of the tendon