What are the typical symptoms and clinical presentation of bicipital tendinitis?

Bicipital Tendinitis Symptoms

Patients with bicipital tendinitis typically present with a deep, throbbing ache in the anterior shoulder that is load-related and worsens with repetitive overhead arm motion. 1

Primary Clinical Presentation

Pain characteristics:

• Pain develops insidiously and is directly related to activity level 2
• Described as "sharp" or "stabbing" localized to the anterior shoulder and bicipital groove 2, 1
• Initially occurs only during activity but progresses to rest pain in untreated or chronic cases 2
• Repetitive overhead motion of the arm initiates or exacerbates symptoms 1

Key physical examination findings:

• Bicipital groove point tenderness is the most common isolated clinical finding, best elicited with the arm positioned in 10 degrees of internal rotation 1
• Well-localized tenderness on direct palpation that reproduces the patient's activity-related pain 2, 3
• Swelling, asymmetry, and erythema may be present over the anterior shoulder 3
• Muscle atrophy suggests chronicity 3

Provocative Testing

Specific maneuvers that reproduce pain:

• Shoulder flexion with the elbow extended 4
• Focal digital pressure applied directly to the biceps origin 4
• Biceps retraction test 4
• Hawkins test (forced internal rotation with arm passively flexed to 90 degrees) - sensitive (92%) but not specific (25%) 2
• Neer test (complete forward flexion between 70-120 degrees) - sensitive (88%) but not specific (33%) 2

Important Clinical Distinctions

Pathophysiology clarification:

• The underlying pathology is degenerative tendinopathy (tendinosis) rather than acute inflammation, characterized by collagen disorientation and fiber separation 3, 5
• Histologic studies demonstrate chronic degenerative changes with tenocyte proliferation, myxoid degeneration, and increased vascularization—not acute inflammation 5
• Only 5% of cases represent true primary biceps tendinitis (isolated inflammation of the bicipital groove) 1

Associated pathology:

• Biceps tendinitis is commonly accompanied by rotator cuff tears or SLAP (superior labrum anterior to posterior) lesions 1
• When multiple tendons are symptomatic simultaneously, evaluate for underlying rheumatic disease 2

Common Diagnostic Pitfalls

• Avoid mislabeling chronic degenerative cases as "tendinitis" when they represent tendinosis, as this leads to inappropriate reliance on anti-inflammatory treatments that provide only short-term relief 3
• The Hawkins and Neer tests are sensitive but not specific; positive results require correlation with other clinical findings 2
• Limited range of motion indicates chronicity and more advanced disease 3