Author: Erik Versluis, Physical therapist
Published
⏱ Reading time: 6 minutes
Biceps Tendon Treatment
Pain at the front of the shoulder is often related to problems of the biceps tendon, specifically the long head of the biceps. This tendon runs through the shoulder joint and is closely connected to other shoulder structures such as the rotator cuff.
Biceps tendon problems can lead to pain, weakness, clicking sensations, or loss of function. In most cases, symptoms can be treated successfully with physiotherapy, although injections or surgery may sometimes be required.
Anatomy and Function of the Biceps Tendon
The biceps muscle consists of two muscle bellies:
The short head, attaching to the front of the shoulder blade
The long head, running through the shoulder joint and attaching at the top of the shoulder socket
At the elbow, both muscle bellies merge into one tendon that helps bend the elbow and rotate the forearm.
The long head of the biceps tendon also plays a supportive role in shoulder stability, especially when the rotator cuff is overloaded or weakened.
Common Biceps Tendon Disorders
1. Biceps Tendinitis / Tendinopathy
This is an overload-related condition of the long head of the biceps tendon. It may develop due to:
Repetitive overhead activities
Sudden increase in training or workload
Age-related tendon degeneration
Typical symptoms include pain at the front of the shoulder, tenderness, and pain during lifting, reaching or crossing you arm in front of the body.
2. Biceps Tendon Subluxation or Dislocation
The biceps tendon normally runs in a bony groove at the front of the upper arm bone. If the surrounding stabilising tissue structures are damaged, the tendon may partially or fully slip out of place.
This can cause:
Sharp anterior shoulder pain
Clicking or snapping sensations
Pain during rotation or lifting movements
3. Partial or Complete Biceps Tendon Tears
A torn biceps tendon can occur due to trauma or long-term degeneration. In complete ruptures, the muscle may retract, creating a visible “Popeye” deformity.\
Despite the dramatic appearance, many people maintain reasonable strength and function.
Diagnosis
Diagnosis is based on:
A detailed medical history
Physical examination using specific shoulder tests
Ultrasound imaging, which is particularly useful for visualising inflammation, instability or tears of the biceps tendon
Ultrasound allows dynamic assessment while moving the shoulder.
👉 Read more about ultrasound assessment at Fysiotherapie Middenweg
Treatment Options for Biceps Tendon Problems
Physiotherapy
Physiotherapy is the first-line treatment for most biceps tendon disorders and focuses on:
Reducing pain and irritation
Improving shoulder and scapular control
Gradually restoring strength and load tolerance
Treatment is tailored to daily activities, work demands and sports participation.
Injection Therapy
If pain persists despite physiotherapy, an ultrasound-guided corticosteroid injection may be considered to reduce inflammation and pain.
Injections are usually combined with an active rehabilitation programme.
Surgical Treatment
Surgery is reserved for:
Persistent symptoms despite conservative care
Severe tendon damage
Combined shoulder pathology
Common procedures include:
Biceps tenodesis – reattaching the tendon outside the shoulder joint
Biceps tenotomy – releasing the tendon without reattachment
Recovery and Prognosis
Conservative treatment often leads to improvement within 6–12 weeks
After surgery, rehabilitation to take several months depending on the procedure
According to my clinical expertise, most patients regain good shoulder function and return to daily activities or sports.
Frequently Asked Questions about Biceps Tendon Treatment
1. What does the biceps tendon do?
The biceps tendon helps bend the elbow, rotate the forearm, and supports shoulder stability during overhead movements.
2. Where is biceps tendon pain usually felt?
Pain is typically felt at the front of the shoulder and may radiate down the upper arm.
3. Can biceps tendon pain go away on its own?
Mild cases may improve, but persistent symptoms usually require targeted physiotherapy.
4. Is physiotherapy effective for biceps tendon problems?
Yes. Most patients recover well with a structured rehabilitation programme.
5. Do I always need an injection?
No. Injections are only considered when physiotherapy alone is insufficient and pain persists.
6. How long does recovery take?
Recovery varies but often takes 6–12 weeks with conservative treatment.
7. Can I keep training with biceps tendon pain?
Modified activity is often possible, but painful movements should be avoided initially.
8. Is surgery always necessary after a tendon tear?
No. Many people function well without surgery, even after a complete rupture.
9. What exercises are commonly used in treatment?
Exercises focus on shoulder stability, rotator cuff strength, scapular control and gradual biceps loading.
10. Can biceps tendon problems return?
Yes, especially if shoulder load increases too quickly. Proper rehabilitation reduces recurrence risk. In case of a spontaneous rupture of the long head of the biceps in older patients, surgery is not required. Functional recovery of the shoulder function can be expected in the long term.