Tendonitis
Bicipital tendonitis is a very common condition affecting the front of the shoulder or elbow. The biceps muscle flexes our elbow and aids in flexing of the shoulder. The bicep muscle is made of 2 seperate muscle that share a common attachment. The muscle attaches to forearm bone called the ulna at a common site. The origination of the muscle is in 2 separate location on the shoulder blade. The first attachment is in the front of the shoulder just under the collar bone to a protrusion off the scapula called the coracoid process. The second attachment is just above the cup on the scapula where the arm bone ball articulates to make the shoulder joint. The most common site of tendonitis called proximal bicipital tendonitis occurs at the location where the bicipital tendon takes a 90 degree turn after passing through the bicipital grove before attaching above the shoulder cup. The second site site of tendonitis called distal bicipital tendonitis occurs at the attachment of the biceps muscle at the elbow.
Symptoms of Proximal Tendonitis
- Pain in the front of the shoulder during hand elevation overhead.
- Pain in front of shoulder while reaching backward.
- Pain in the front of the shoulder flexing the elbow
Symptoms of Distal Tendonitis
- Pain in the front of the elbow when flexing the arm.
- Pain in the front of the elbow when carrying heavy items.
- Pain in the front of the elbow when straightening the arm.
Treatment of Bicipital Tendonitis
First we need to rest the arm. Usually this condition occurs due to overworking the muscle. We then use Chiropractic Care, Acupuncture and Massage Therapy to correct muscle imbalances around the scapula leading to poor mechanics within the shoulder joint. We also instruct patients on stretching muscles to aid in making postural corrections of the shoulder and neck. At home we also recommend Contrast Therapy to decrease inflammation and speed healing.
Conditions That Mimic Bicipital Tendonitis
Bicipital tendonitis — inflammation of the long head of the biceps tendon — often causes pain in the front of the shoulder that may worsen with lifting, overhead motions, or rotation of the arm. However, many shoulder conditions share similar symptoms, making accurate diagnosis essential. One common mimic is rotator cuff tendinopathy or tear, which can also produce anterior shoulder pain, weakness, and difficulty lifting the arm. Shoulder impingement syndrome can look very similar, as the rotator cuff and biceps tendon both pass through a crowded subacromial space, leading to overlapping patterns of pain. Another frequent imitator is labral pathology (such as a SLAP tear), which can cause pain in the same area, especially with overhead movements, and may even coexist with biceps irritation. Frozen shoulder (adhesive capsulitis) sometimes mimics bicipital tendonitis in its early stages, with vague anterior pain before stiffness becomes the main feature. Pain from cervical spine disorders, such as cervical radiculopathy, can also radiate to the front of the shoulder and be mistaken for local tendon irritation. Finally, acromioclavicular (AC) joint arthritis or even pectoralis minor tightness may create discomfort in a very similar location. Because these conditions overlap in presentation, physical exam tests (like Speed’s or Yergason’s for biceps tendon), combined with imaging when needed, are important to distinguish the true source of pain. For patients, this means that self-diagnosing shoulder pain as bicipital tendonitis can be misleading — a careful evaluation by a chiropractor or other musculoskeletal specialist ensures that treatment targets the correct problem for lasting relief.