Proximal Biceps Tendon Tendinitis

What is Proximal Biceps Tendon Tendinitis

Proximal biceps tendon tendinitis and tenosynovitis are usually caused by overusing the shoulder joint and the biceps muscle. These conditions usually heal within 6 weeks.

The proximal biceps tendon is a strong cord of tissue that connects the biceps muscle, on the front of the upper arm, to the shoulder blade. Tendinitis is inflammation of a tendon.

Tenosynovitis is inflammation of the lining around the tendon (tendon sheath). These conditions often occur at the same time, and they can interfere with the ability to bend the elbow and turn the hand palm-up (supination).

Proximal biceps tendon tendinitis may include a grade 1 or grade 2 strain of the tendon. A grade 1 strain is mild, and it involves a slight pull of the tendon without any stretching or noticeable tearing of the tendon. There is usually no loss of biceps muscle strength. A grade 2 strain is moderate, and it involves a small tear in the tendon. The tendon is stretched, and biceps strength is usually decreased.

What are the causes?

This condition may be caused by:

  • A sudden increase in frequency or intensity of activity that involves the shoulder and the biceps muscle.
  • Overuse of the biceps muscle. This can happen when you do the same movements over and over, such as:
    • Supination.
    • Forceful straightening (hyperextension) of the elbow.
    • Bending the elbow.
  • A direct, forceful hit or injury (trauma) to the elbow. This is rare.

What increases the risk?

The following factors may make you more likely to develop this condition:

  • Playing contact sports.
  • Playing sports that involve throwing and overhead movements, including racket sports, gymnastics, weight lifting, or bodybuilding.
  • Doing physical labor.
  • Having poor strength and flexibility of the arm and shoulder.

What are the signs or symptoms?

Symptoms of this condition may include:

  • Pain and inflammation in the front of the shoulder. Pain may get worse with movement, especially when you use resistance, as in weight lifting.
  • A feeling of warmth in the front of the shoulder.
  • Limited range of motion of the shoulder and the elbow.
  • A crackling sound (crepitation) when you move or touch the shoulder or the upper arm.

In some cases, symptoms may return (recur) after treatment, and they may be long-lasting (chronic).

How is this diagnosed?

This condition is diagnosed based on your symptoms, your medical history, and a physical exam. You may have tests, including X-rays or MRIs. Your health care provider may test your range of motion by asking you to do arm movements.

How is this treated?

This condition is treated by resting and icing the injured area, and by doing physical therapy exercises. Depending on the severity of your condition, treatment may also include:

  • Medicines to help relieve pain and inflammation.
  • Ultrasound therapy. This is the application of sound waves to the injured area.
  • Injecting medicines (corticosteroids) into your tendon sheath.
  • Injecting medicines that numb the area (local anesthetics).
  • Surgery to remove the damaged part of the tendon and reattach the undamaged part of the tendon to the arm bone (humerus). This is usually only done if you have symptoms that do not get better with other treatment methods.

Follow these instructions at home:

Managing pain, stiffness, and swelling

  • If directed, put ice on the injured area:
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Move your fingers often to avoid stiffness and to lessen swelling.
  • Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

If directed, apply heat to the affected area before you exercise. Use the heat source that your health care provider recommends, such as a moist heat pack or a heating pad.

  • Place a towel between your skin and the heat source.
  • Leave the heat on for 20–30 minutes.
  • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.


  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Do notlift anything that is heavier than 10 lb (4.5 kg) until your health care provider tells you that it is safe.
  • Avoid activities that cause pain or make your condition worse.
  • Do exercises as told by your health care provider.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Do notdrive or operate heavy machinery while taking prescription pain medicines.
  • Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

  • Warm up and stretch before being active.
  • Cool down and stretch after being active.
  • Give your body time to rest between periods of activity.
  • Make sure any equipment that you use is fitted to you.
  • Be safe and responsible while being active to avoid falls.
  • Do at least 150 minutes of moderate-intensity aerobic exercise each week, such as brisk walking or water aerobics.
  • Maintain physical fitness, including:
    • Strength.
    • Flexibility.
    • Cardiovascular fitness.
    • Endurance.

Contact a health care provider if:

  • You have symptoms that get worse or do not get better after 2 weeks of treatment.
  • You develop new symptoms.

Get help right away if:

  • You develop severe pain.

Biceps Tendon Tendinitis (Proximal) and Tenosynovitis Rehab

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your arm and shoulder. These exercises also help to relieve pain and stiffness.

Exercise A: Shoulder flexion

  1. Stand facing a wall. Put your left / right hand on the wall.
  2. Slide your left / right hand up the wall. Stop when you feel a stretch in your shoulder, or when you reach the angle that is recommended by your health care provider.
    • Use your other hand to help raise your arm, if needed.
    • As your hand gets higher, you may need to step closer to the wall.
    • Avoid shrugging your shoulder while you raise your arm. To do this, keep your shoulder blade tucked down toward your spine.
  3. Hold for __________ seconds.
  4. Slowly return to the starting position. Use your other arm to help, if needed.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Posterior capsule stretch (

passive horizontal adduction)

  1. Sit or stand and pull your left / right elbow across your chest, toward your other shoulder. Stop when you feel a gentle stretch in the back of your shoulder and upper arm.
    • Keep your arm at shoulder height.
    • Keep your arm as close to your body as you comfortably can.
  2. Hold for __________ seconds.
  3. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your arm and shoulder. Endurance is the ability to use your muscles for a long time, even after your muscles get tired.

Exercise C: Elbow flexion, supinated

  1. Sit on a stable chair without armrests, or stand.
  2. If directed, hold a __________ weight in your left / right hand, or hold an exercise band with both hands. Your palms should face up toward the ceiling at the starting position.
  3. Bend your left / right elbow and move your hand up toward your shoulder. Keep your other arm straight down, in the starting position.
  4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Scapular protraction, supine

  1. Lie on your back on a firm surface. If directed, hold a __________ weight in your left / right hand.
  2. Raise your left / right arm straight into the air so your hand is directly above your shoulder joint.
  3. Push the weight into the air so your shoulder lifts off of the surface that you are lying on.Do notmove your head, neck, or back.
  4. Hold for __________ seconds.
  5. Slowly return to the starting position. Let your muscles relax completely before you repeat this exercise.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Scapular retraction

  1. Sit in a stable chair without armrests, or stand.
  2. Secure an exercise band to a stable object in front of you so the band is at shoulder height.
  3. Hold one end of the exercise band in each hand.
  4. Squeeze your shoulder blades together and move your elbows slightly behind you. Do notshrug your shoulders.
  5. Hold for __________ seconds.
  6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.


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