Symptoms of Biceps Tendinitis
Biceps tendinitis typically presents with deep, throbbing anterior shoulder pain that worsens with repetitive overhead arm motion, accompanied by well-localized tenderness over the bicipital groove when the arm is positioned in 10 degrees of internal rotation. 1
Primary Clinical Presentation
Pain Characteristics
- Deep, throbbing ache in the anterior shoulder is the hallmark complaint 1
- Pain described as "sharp" or "stabbing" in quality 2
- Insidious onset of load-related, localized pain coinciding with increased activity 2
- Pain initially present during activity but may subside after a warm-up period in early stages 2
- Pain gradually increases in intensity and duration, eventually present at rest in later stages 2
- Repetitive overhead motion of the arm initiates or exacerbates symptoms 1
Physical Examination Findings
- Bicipital groove point tenderness with the arm in 10 degrees of internal rotation is the most common isolated clinical finding 1
- Well-localized tenderness on palpation that reproduces the patient's activity-related pain 2
- Swelling, erythema, and asymmetry commonly noted when examining the affected tendon 2
- Limited range of motion on the symptomatic side 2
Chronic Presentation Features
Signs of Chronicity
- Muscle atrophy is often present with chronic conditions and provides an important clue to symptom duration 2
- Patients typically have prolonged symptoms before presentation, by which time acute inflammation has subsided and been replaced by tendon degeneration 2
Important Distinguishing Features
- Joint effusions are uncommon with biceps tendinopathy and should raise suspicion for intra-articular pathology requiring different evaluation 2
- Most patients report engaging in a new activity or increasing intensity of current activity before symptom onset, though not all 2
Common Pitfalls
Misdiagnosing biceps tendinopathy as purely inflammatory ("tendinitis") rather than recognizing the degenerative component ("tendinosis") can lead to inappropriate treatment focus, as histologic analysis demonstrates changes in tenocyte size, ground substance, collagen organization, and vascularity rather than acute inflammation 3, 4