Tendinopathy of the long head of biceps
The biceps muscle bends the elbow and brings the hand upwards. It has two tendons, the long head and the short head, and the long head passes upwards in a groove at the front of the shoulder into the subacromial space where it can be involved in impingement syndrome.
Pain will be felt at the front tip of the shoulder on bending the elbow upwards against resistance and a nipping pain may be felt when lifting the arm forwards at shoulder height.
Physiotherapy can help with treatment including a specific massage technique to the painful area, called frictions, and mobilisations. Electrotherapy may be used, particularly ultrasound. Activities that aggravate the pain should be avoided initially but exercises will be given that improve the strength of the biceps muscle and tendon. Advice will also given on posture to help to prevent recurrence. In cases that don’t respond to this conservative management, an injection may be given into the sheath that surrounds the tendon, rather than directly into the tendon itself.