Kyle didn't pitch many innings in Little League and middle school. He mostly came
in for short stints as a reliever. But in high school, the coach thought Kyle had
a great arm and put him in the starting rotation. Soon Kyle was pitching more than
One day in the middle of the season, Kyle felt pain in his shoulder and upper arm
after pitching a game. The next day it still hurt, so he told his coach. The coach
took Kyle out of the rotation and recommended he see a doctor. The doctor examined
Kyle's shoulder and said he probably had a case of proximal biceps tendonitis and
would have to rest his arm for a few weeks.
What Is Biceps Tendonitis?
The biceps is the muscle in your upper arm that you flex when you bend your arm
or show off your muscles. This muscle also helps you twist your forearm outward. Tough
connective tissues called tendons attach the biceps muscle to the
elbow and shoulder and help you move your arm.
The tendon that attaches the lower part of the biceps to the elbow is the distal
tendon. The tendons that attach the top of the biceps muscle to the shoulder
are the proximal tendons.
There are two proximal tendons — the long head and the short
head. They attach to your shoulder blade in different places to hold the
top of your upper arm bone firmly in your shoulder socket while still allowing it
If any of these tendons become swollen or irritated from overuse, it can lead to
a condition called biceps tendonitis. If you have biceps tendonitis,
it can hurt just to move your arm. The good news is, most cases heal on their own
with rest and medication.
Signs of Proximal Biceps Tendonitis
Proximal biceps tendonitis usually starts out slowly and becomes more painful the
more a person uses that arm. But sometimes an injury or small tear in the tendon can
cause problems right away.
Some of the more common signs of proximal biceps tendonitis include:
pain in the front or side of the shoulder and the upper arm
pain in the arm at night, especially when you sleep on that side
pain when you move your arm, raise it above your head, or reach behind you
shoulder weakness and stiffness
loss of some motion in the arm
What Causes It?
The word "tendonitis" simply means that the tendon is irritated and swollen. In
teens, biceps tendonitis is usually an overuse injury. Baseball pitchers, swimmers,
tennis players, and people who have to reach above their heads a lot are at greater
risk because of the repeated stress on their shoulders and upper arms.
Proximal biceps tendonitis often happens along with other shoulder problems. In
most cases, there is also damage to another shoulder tendon called a rotator
How Do Doctors Diagnose It?
If your shoulder and upper arm hurt when you move your arm, and you're worried
that you might have biceps tendonitis, call a doctor.
The doctor will examine you and ask about any activities you've been doing that
might have caused the problem. He or she will also check the strength and range of
motion in your shoulder and look to see if it feels loose or unstable. For more serious
cases (or to rule out other problems), the doctor might want you to have an X-ray,
ultrasound, or magnetic
resonance imaging (MRI) scan.
How Can I Prevent Biceps Tendonitis?
The best way to prevent biceps tendonitis is to avoid activities that put your
arms above your head a lot. But if you swim or play tennis or baseball, that might
not be an option!
If your activities put you at risk for biceps tendonitis, you'll want to do exercises
that strengthen the muscles of your shoulder and upper arm. Strong muscles will keep
the entire area more stable and less likely to get injured.
If you play a sport that puts you at greater risk of biceps tendonitis, make sure
you know the right way to play. Playing in the wrong way can put your arm in weird
positions that may put added stress on your shoulder. As much as you can, try to avoid
reaching above your head or doing other things that require a lot of shoulder movement.
Most important, if you feel any pain in your shoulder or upper arm, stop doing
the activity that might be causing it right away. Don't start the activity again until
the pain is gone or a doctor has told you it's OK. Never try to ignore pain
or play through it. This will most likely only make the condition worse.
How Should I Treat Biceps Tendonitis?
Most cases of biceps tendonitis can be treated at home with fairly simple methods.
Although doctors sometimes need to do surgery to repair badly injured proximal biceps
tendons, it's usually for adults. Kids and teens almost never need surgery for this
kind of injury.
Treatment can include the following:
Rest your arm. Stop doing activities that require a lot of shoulder
movement and try to avoid using your injured arm for any lifting or reaching.
Ice the affected area. Apply ice or a cold compress to your shoulder
for up to 20 minutes several times a day to help keep the swelling down. (Never apply
ice directly to the skin.)
Take anti-inflammatory medications. Painkillers such as ibuprofen
can help relieve pain and reduce swelling in the shoulder and upper arm. The doctor
also may recommend a cream or patch that can be applied to the skin. In some cases,
doctors may give people steroid injections to ease pain and help reduce swelling.
Do stretching and strengthening exercises. These will help strengthen
your shoulder and restore its range of motion. Strengthening and stretching exercises
can help you recover and make you less likely to reinjure your arm. A doctor or a
physical therapist can work with you to develop a good exercise program.
The good news about proximal biceps tendonitis is that most cases heal just fine
on their own. But it does require patience. The key with this kind of injury is to
give your arm plenty of time to rest. You don't want to jump back into your sport
or activity too soon or you'll risk making things worse and spending even more time
on the sidelines!