Long head biceps tendinopathy (proximal) refers to tendinopathy of the tendon that attaches the biceps to the shoulder. It is an inflammation and overuse injury of the tendon. Although pain may originate from the tendon and the tendon sheath, the cause is often related to how the shoulder joint moves and the interaction of the muscles of the shoulder working together to create movement. The long head biceps tendon acts as a stabiliser at the front of the shoulder and repetitive loading can tether at the tendon if the biomechanics in the shoulder is suboptimal.


Being a tendinopathy, biceps tendinopathy is an overuse condition, whereby the activity that you were recently doing exceeded the capacity that these tendons were able to handle. It may also be related to shoulder laxity or instability causing the ball of the arm bone to apply repetitive pressure at the tendon.


What are the characteristics of activities that cause long head biceps tendinopathy?

  • Repetitive shoulder movement especially at or above 90 degrees e.g. swimming, tennis, throwing
  • You may be using the shoulder more due to another injury


Signs and symptoms of long head biceps tendinopathy

  • Pain in the shoulder as you lift your arm up in front, in particular past 90 degrees
  • Pain with throwing action
  • Pain with bearing weight through your hands
  • Pain may be felt when you use your elbow
  • Weakness at the shoulder or elbow
  • Pain lying on the injured shoulder
  • Although painful, you are still able to reach full range


What does the science currently say?

  • The long head biceps tendon acts as a dynamic stabiliser of the shoulder much like the rotator cuff, therefore they need to be strengthened as a stabiliser for it to be able to handle the repetitive loads placed on it


How can Physiotherapy help?

Your Physiotherapist will be able to:

  • Help you identify aggravating activities
  • Help you identify positions of comfort
  • Provide manual therapy to reduce pain, tightness and improve movement
  • Identify the biomechanics of your shoulder joint and guide you through strengthening and scapular stabilisation exercises to improve them