What is biceps tendinitis?

Biceps tendinitis is a painful shoulder ailment that affects both the front and back of the shoulder. It affects people of all ages, but is particularly common among those who lift weights in the gym and participate in overhead sports like tennis. Your clinician will perform an ultrasound scan during your initial appointment to see if your tendon is damaged or irritated. Physiotherapy is often effective in treating biceps tendinitis. If your discomfort isn’t going away or keeping you awake at night, an ultrasound-guided steroid injection combined with physiotherapy can provide pain relief and help you get back to full function as quickly as possible. 

Your Care Pathway with us

  • To book an appointment you can call on, 020 8870 8761, email direct to 
  • Complete MSK Examination and testing.
  • Discussion of your treatment plan; Treatment Plans can include Ultrasound Guided Cortisone Injection and Ostenil plus (Hyaluronic injection) 

What are the symptoms of biceps tendinitis?

The symptoms of a biceps tendinitis are:

  • The front of the shoulder hurts.
  • Moving your arm forward (flexion) and overhead movements cause pain.
  • On the front of the shoulder, there is a tenderness.

What conditions can be mistaken for biceps tendinitis?

If this does not seem like your problem, there are a number of different conditions that can cause discomfort similar to biceps tendinitis, including:

  1. Frozen shoulder
  2. Sub-acromial bursitis
  3. Calcific tendinopathy
  4. Shoulder impingement
  5. Rotator cuff pain.

Biceps tendinitis vs rotator cuff pain

Biceps tendinitis causes severe pain and stiffness at the front of the shoulder, whereas rotator cuff pain is more common and causes pain all over the shoulder and down the side of the arm. Rotator cuff pain is frequently linked to increased weakness.


The bicep muscle is a huge muscular mass at the front of the upper arm that many bodybuilders work out in the gym on a regular basis.

Your elbow flexes (bends) and supinates when you engage your bicep muscle (palm of hand turns upwards). The bicep also aids in the forward movement of your arm by assisting your shoulder muscles.

The bicep muscle has two heads: a long head and a short head (as shown in the illustration below). Both bicep heads are made up of tendons that link to the shoulder joint. The coracoid process is a bony protrusion where the short head of the bicep tendon attaches. Because this region of the bicep muscle is rarely injured, it is not covered in this article.

injections for Biceps tendonitis in UK

The long head of the bicep tendon joins to the supraglenoid tubercle, a tiny bony protrusion deep inside the shoulder joint that aids in shoulder stabilisation. It is frequently injured and is a well-known source of symptoms in patients with shoulder pain.

What is the most common symptom of biceps issue?

The symptoms vary, but a bicep tendon injury can cause pain in the front, outside, or both of the shoulders. The discomfort can also radiate down the arm, chest, and elbow, distant from the actual tendon area.

Certain shoulder movements, particularly those above shoulder level, aggravate the pain. Increased discomfort occurs when you move your arm forward, out to the side, or even behind your back.

Bench presses and overhead presses in the gym can increase the symptoms. A bicep curl, on the other hand, is usually pain-free since it works the tendon at the elbow, not the shoulder. You may have injured the distal biceps tendon if you experience pain in your elbow when performing biceps curls.

long head Biceps tendonitis pain injections

The pain is usually stronger at night and can even wake you up if you rest on it or stretch your arm out. If you sleep on your sore side, the symptoms can be exacerbated by moving around first thing in the morning.

How does the biceps become injured?

Long head of bicep injuries can occur for a variety of reasons. They range from lifting excessively heavy weights at the gym to lugging grocery bags home from the store. If you fall while skiing or cycling, you could injure your biceps. It’s not uncommon for pain to strike without warning and for symptoms to appear for no apparent reason.

The beginning of discomfort will also be determined by the sort of long head of bicep injury you have. The many varieties will be explored further down.

What are the different types of biceps problems?

Long head of bicep tendon pain is frequently associated with other shoulder problems, such as rotator cuff tears or tendinopathy. The rotator cuff is a group of deep muscles in the shoulder that help in stability and rotation (Atsushi et al, 2016).

The long head of the bicep tendon is encased in a tendon sheath and lies in a groove in the upper arm. A tendon sheath is a tissue layer that surrounds a tendon. Tendon injuries can affect either the tendon or the tendon sheath:

  1. Tendon injuries – These arise as a result of overuse of the tendon or as a result of a fall or accident, resulting in tendon pain and swelling. Tendonopathy is the medical term for this condition. Tendon tears can occur in more severe forms of tendinopathy. Tendonopathy can occur when the tendon slides out of the bone groove it was supposed to sit in. The bicipital groove is the name for this groove. This sliding is caused by a weakness in the underlying ligament, which is responsible for keeping the tendon in the bony groove. Long head of biceps subluxation/dislocation is the medical term for this ailment.
  2. Tenosynovitis –Inflammation of the tendon sheath (the layer of tissue that surrounds the tendon) can be quite painful. 
  3. Rupture – These injuries are uncommon in young athletes, but as they get older, the risk of a long head of bicep tendon rupture increases. When a tendon ruptures, it is torn in two (see image below). After the age of 50, the rate of incidents skyrockets. Tendon rupture accounts for 96% of all long head of bicep injuries in this population (Carter et al, 1999).

The majority of individuals with a long head of biceps rupture have a ‘Popeye Sign’ in their arm (see below). As a result, the diagnosis is rather simple. Due to poor clinical outcomes, surgery on long head of bicep ruptures is not commonly performed in this population. The most typical treatment for long head of bicep tendon ruptures is physiotherapy and exercise prescription.

injections for torn biceps

How do you diagnose biceps tendon problem?

Clinical examination and diagnostic ultrasonography are used to diagnose long head of biceps tendon pain. A number of clinical tests are used to aid in the diagnosis of this disorder; however, research has revealed that many of the clinical tests used to diagnose long head of bicep pathology are ineffective (Chen et al, 2011).

In plain terms, if you suspect you have a biceps problem, a doctor, physiotherapist, or other health expert will need to do a diagnostic ultrasound or MRI scan to confirm the diagnosis.

Diagnostic musculoskeletal ultrasound imaging is equally effective as MRI in identifying shoulder tendon pathology, including long head of biceps abnormalities, according to the data (Joseph, 2009). The use of diagnostic musculoskeletal ultrasonography is crucial for obtaining a definitive diagnosis due to the lack of specific clinical tests.

On your initial visit, we will perform a clinical examination, a diagnostic ultrasound scan, and, if necessary, an ultrasound-guided injection. There is no additional cost for the scan. Diagnostic ultrasound can distinguish between tendinopathy, a tear, tenosynovitis, subluxation/dislocation, and rupture in the long head of the biceps.

How is biceps tendon pain treated?



A progressive strengthening programme designed to restore normal movement and develop strength around the shoulder joint can successfully treat most bicep tendon disorders. Exercises to strengthen the biceps, the rotator cuff tendons, and the scapula muscles will be included. It will also provide suggestions for activity modification and what to avoid.

shoulder physiotherapy

At Joint Injections, we have a staff of highly qualified physiotherapists who can prescribe a rehabilitation regimen that is safe and beneficial for you. If your bicep tendon discomfort does not go away, you have a few more alternatives to assist you relieve the pain and get back to full function.

Ultrasound-guided  injection Therapy for Biceps Tendinitis

If you’ve been diagnosed with a long head of biceps problem and the discomfort isn’t going away, an ultrasound-guided steroid injection may be the answer. Steroid (sometimes called corticosteroid) is a powerful anti-inflammatory drug that is often used in sports medicine. A steroid injection’s purpose is to relieve discomfort so that you may begin a rehabilitation programme that will strengthen your shoulder muscles and allow you to regain full function. The injection creates a “window of opportunity” for you to perform your physiotherapy exercises with minimal or no pain.

It’s implicated in shoulder impingement and can be injected with steroids, especially if a sub-acromial bursa injection hasn’t offered enough pain relief. The long head of the biceps tendon is known as the “fifth” rotator cuff and can cause rotator cuff pain. It’s been shown to exist in conjunction with other shoulder issues such rotator cuff problems and capsulitis (Redondo-Alonso et al, 2014).

For tendinopathy, tenosynovitis, and some partial rips, the injection lowers swelling in and/or around the tendon. It is not recommended for the treatment of a biceps long head rupture. 

In comparison to “blind” landmark guided injections for the treatment of long head of bicep tenosynovitis, a recent systematic review (Eldra et al. 2018) found that ultrasound-guided steroid injection for the treatment of long head of bicep tenosynovitis was significantly more accurate, with (90 percent) of injections successfully targeting the tendon sheath (30 percent ). This large increase in accuracy was demonstrated to be more effective, as evidenced by a significant reduction in pain after injection. 

Ultrasound guidance should be used for steroid injections in the long head of the biceps. If you were diagnosed with a long head of biceps problem and had an unsuccessful unguided steroid injection, the injections most likely did not reach the target tissue/area. A repeat injection under ultrasound guidance can typically provide the desired result in these circumstances.

For the treatment of biceps tendon disorders, non-operative methods such as corticosteroid injections are beneficial. According to Zhang et al. (2011), 80 percent of patients experienced significant pain reduction after receiving an injection into the biceps tendon sheath under ultrasound supervision. When compared to ‘unguided’ or landmark guided injections, patients who underwent an ultrasound-guided injection had a much better outcome.

Joint Injections employs highly qualified physiotherapists, independent prescribers, injection therapists, and musculoskeletal sonographers as clinicians. Using a combination of clinical tests and a diagnostic ultrasound scan, your therapist will be able to formally diagnose your issue at your initial assessment. If an ultrasound-guided injection is judged safe and acceptable, your clinician will discuss it with you. A reference from a doctor is not required. 

Please do not hesitate to contact us if you believe you have a long head of biceps problem or if you would like more information about this diagnosis or our ultrasound-guided injection service.