Biceps tendinopathy at the shoulder is pain and irritation of the long head of the biceps tendon, which runs in a groove at the front of the shoulder before attaching inside the joint. It causes a deep ache at the front of the shoulder that is worse with lifting, reaching overhead and carrying. It rarely occurs alone and is usually found alongside rotator cuff problems, so the whole shoulder needs assessing.
Also known as long head of biceps tendinopathy, biceps tendinitis, bicipital tendinitis
Symptoms
- A deep ache at the front of the shoulder, sometimes spreading down the upper arm
- Pain when lifting, reaching overhead, pulling or carrying with the elbow bent
- Tenderness in the groove at the front of the shoulder
- Clicking or snapping at the front of the shoulder with some movements
- Pain at night, especially lying on that side
- A sudden pop with bruising and a bulge in the upper arm if the tendon ruptures
Causes and risk factors
- Repeated overhead activity in sport or work, such as swimming, throwing, racket sports or decorating
- Rotator cuff tendinopathy or tears, which increase the load on the biceps tendon
- Age-related change in the tendon, most common from middle age
- Shoulder instability or damage to the rim of the socket
- A sudden increase in lifting or pulling
What the evidence says helps
- A systematic review confirmed a close link between long-standing rotator cuff problems and problems in the long head of biceps tendon, which is why both are assessed together.2
- Treatment usually starts without surgery: easing off aggravating activities for a while, pain relief and a progressive exercise programme for the shoulder.13
- A steroid injection around the tendon is sometimes used to ease pain if exercise-based care is not enough.1
- Surgery to release or re-anchor the tendon is kept for people whose symptoms persist despite good conservative care.1
- If the tendon ruptures, many older and less active people manage well without surgery, although the arm may look different and can feel a little weaker when twisting the forearm.1
Things you can try at home
- Ease off heavy lifting, overhead work and pulling for a few weeks, without resting the arm completely
- Carry loads close to your body with the elbow tucked in
- Use ice or heat for short-term relief, whichever you find helps
- Build strength back gradually, staying within mild discomfort
- Avoid sleeping on the sore side, or support the arm with a pillow
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- Shoulder or arm pain with chest pain, breathlessness, sweating or pain in the jaw: call 999
- A shoulder that looks deformed or cannot be moved after a fall or injury: go to A&E
- A hot, red, swollen shoulder with a fever or feeling unwell: get same-day medical help
- Constant pain that is worse at night, with unexplained weight loss or a history of cancer: see your GP
- A sudden pop at the shoulder or elbow with bruising, a bulge in the upper arm or new weakness: see a GP or minor injuries unit promptly
How Apollo can help
We examine the whole shoulder, not only the biceps tendon, because the rotator cuff and shoulder blade muscles are usually involved too. We explain what is driving the pain and agree how to adjust lifting, work and sport while it settles. Your plan centres on progressive strengthening for the shoulder and arm, with hands-on treatment where it helps, and we can measure shoulder strength to track progress. If we suspect a rupture or a significant tear, or you are not improving, we refer you to your GP for a scan or specialist opinion.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
How do I know if my shoulder pain is from the biceps tendon?
Biceps tendon pain is felt at the front of the shoulder and is tender in the groove where the tendon runs. It is worse with lifting and reaching with the elbow bent. Because it usually comes with rotator cuff problems, an examination of the whole shoulder is needed to be sure.
How long does biceps tendinopathy take to heal?
Tendon problems improve slowly. With sensible changes to activity and a strengthening programme, many people notice steady improvement over two to three months, although it can take longer if the rotator cuff is also involved.
What happens if the biceps tendon snaps?
A rupture of the long head causes a sudden pop, bruising and a bulge in the upper arm. Pain often eases afterwards. Many people, especially those who are older or less active, manage well without surgery, but it should be checked by a clinician.
References
- Nho SJ, et al. (2010). Long Head of the Biceps Tendinopathy: Diagnosis and Management. American Academy of Orthopaedic Surgeon 18:645-656. View source
- Redondo-Alonso L, Chamorro-Moriana G, Jiménez-Rejano JJ, López-Tarrida P, Ridao-Fernández C (2014). Relationship between chronic pathologies of the supraspinatus tendon and the long head of the biceps tendon: systematic review. BMC Musculoskeletal Disorders 15. View source
- Krupp RJ, Kevern MA, Gaines MD, Kotara S, Singleton SB (2009). Long Head of the Biceps Tendon Pain: Differential Diagnosis and Treatment. Journal of Orthopaedic & Sports Physical Therapy 39:55-70. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
