Long Head of Biceps Tendinopathy: Causes and Treatment

The long head of the biceps (LHB) tendon connects the biceps muscle to the top of the shoulder joint (glenoid). Tendinopathy of this tendon involves degeneration or inflammation due to overuse, trauma, or other underlying shoulder issues.

Causes of Long Head of Biceps Tendinopathy

1. Overuse and Repetitive Activities
   • Repetitive overhead movements (e.g., throwing, swimming, tennis) can cause microtrauma to the tendon.
2. Shoulder Instability or Impingement
   • Poor shoulder mechanics can compress the tendon within the shoulder joint, leading to irritation.
3. Rotator Cuff Injuries
   • Tendinopathy often coexists with rotator cuff issues, as both structures are anatomically and functionally linked.
4. Age-Related Degeneration
   • The tendon becomes less resilient with age, making it more susceptible to wear and tear.
5. Trauma
   • Direct injuries, such as falling on an outstretched arm, can lead to acute inflammation or damage.
6. Biceps Labral Complex Lesions (SLAP Tears)
   • Tears where the biceps tendon attaches to the labrum can lead to tendinopathy.
7. Postural Issues
   • Poor posture (e.g., forward shoulder position) increases strain on the tendon.

Symptoms of Long Head of Biceps Tendinopathy

• Pain:
  • Front of the shoulder, radiating down the arm.
  • Worsened by lifting, pulling, or overhead activities.
• Tenderness:
  • Pain when pressing over the bicipital groove (the tendon’s path).
• Weakness:
  • Difficulty lifting or performing overhead motions.
• Clicking or Snapping Sensation:
  • May occur with shoulder movement in some cases.

Treatment Options for Long Head of Biceps Tendinopathy

Non-Surgical Treatments

1. Rest and Activity Modification
   • Avoid aggravating activities, especially those involving repetitive or overhead motions.
2. Ice Therapy
   • Apply ice packs for 15–20 minutes to reduce inflammation.
3. Anti-Inflammatory Medications
   • NSAIDs like ibuprofen to alleviate pain and swelling.
4. Physical Therapy
   • Stretching Exercises: Improve flexibility in the shoulder and surrounding muscles.
   • Strengthening Exercises: Focus on the rotator cuff and scapular stabilizers to improve shoulder mechanics.
   • Eccentric Loading: Targeted exercises to strengthen the biceps tendon and reduce pain.
   • Postural Corrections: Address underlying biomechanical issues.
5. Corticosteroid Injections
   • Localized injections to reduce inflammation in persistent cases.
6. Ultrasound or Laser Therapy
   • Promote healing and reduce tendon irritation.

Surgical Treatments (for severe or unresponsive cases)

1. Tenotomy:
   • Cutting the tendon to release it, commonly used in older, less active patients.
2. Tenodesis:
   • Reattaching the tendon to a different location on the humerus, preserving some of its function.
   • Common in younger, more active individuals.

Prevention Tips for Long Head of Biceps Tendinopathy

• Warm up and stretch before physical activity.
• Avoid repetitive overhead activities or heavy lifting without proper technique.
• Strengthen the rotator cuff and scapular muscles.
• Maintain proper posture, especially during desk work or physical tasks.
• Address underlying shoulder conditions early to prevent strain on the biceps tendon.