Rotator cuff

Biceps Tendinitis (Long Head)

Inflammation of the long head of biceps in the bicipital groove. Often associated with rotator cuff pathology.

The long head of biceps tendinitis is an inflammation of the biceps tendon in the bicipital groove (intertubercular sulcus of the humerus). It is rarely isolated and is most often associated with rotator cuff pathology (subacromial impingement, rotator cuff tear) or SLAP lesion. The long head of biceps is a secondary humeral head depressor and anterior stabilizer of the glenohumeral joint. Instability of the tendon in the groove (subluxation or dislocation) indicates subscapularis tear (biceps pulley). Treatment is primarily conservative, but tenodesis or tenotomy may be considered for chronic resistant cases.

Characteristics

  • Pain in the anterior shoulder, localized to the bicipital groove. Worsened by resisted forearm supination and elbow flexion. Night pain possible.
  • Speed's test (palm-up test): anterior shoulder pain on resisted flexion with extended elbow and supinated forearm. Yergason's test: pain on resisted supination with elbow flexed at 90°.
  • Ultrasound: visualization of the tendon in the bicipital groove. Detection of effusion, thickening, subluxation or dislocation. Dynamic assessment during rotation.

Medical and surgical management

  • Conservative treatment first line: NSAIDs, cryotherapy, activity modification, physiotherapy. Ultrasound-guided intra-sheath corticosteroid injection if resistant.
  • Biceps tenodesis: fixation of the biceps tendon in the proximal humerus (interference screw or anchor) with intra-articular section. Preferred in active patients < 55 years.
  • Biceps tenotomy: simple tendon section at its intra-articular origin. Rapid recovery but risk of Popeye deformity (20-30%). Preferred in patients > 55-60 years.

Physiotherapy rehabilitation

  • Activity modification: avoid provocative movements (repetitive overhead, carrying with supination). Relative rest, cryotherapy.
  • Strengthening of the rotator cuff and scapular stabilizers to reduce the load on the biceps tendon. Dynamic humeral head re-centering.
  • Gentle stretching of the biceps and anterior shoulder. Manual therapy: bicipital groove soft tissue mobilization.
  • Post-operative (tenodesis/tenotomy): progressive mobilization from W2. Strengthening from W6. Return to sports at 3-4 months.

Average duration

4 to 12 weeks

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Scientific sources

General information only: this content cannot provide a diagnosis or prescription. A healthcare professional must assess your situation.