Experiencing pain at the front of the shoulder is often due to a long head of biceps tendinopathy. The biceps brachii muscle is situated in the upper arm and is comprised of two heads. The short head attaches proximally to the coracoid process of the scapula (shoulder blade), whilst the long head runs through the bicipital groove of the humerus and then proximally attaches to the supraglenoid tubercle of the shoulder blade. The long head tendon is therefore located in the subacromial space. The subacromial space is located between the superior acromion of the shoulder blade and the humeral head of the humerus bone. The long head of biceps tendon is not alone in this space however, with the space also containing rotator cuff tendons, the coracoacromial ligament and the large subacromial bursa.

Why is the anatomy of the shoulder important to know is because when we manage the long head of biceps tendinopathy, we are effectively managing it like rotator cuff related shoulder pain. Definitively diagnosing the reason for the pain is due to a long head of biceps tendinopathy is quite difficult to do. Shoulder pain is much more complex then that. For more information on rotator cuff related shoulder pain, read our page on the very topic which can be found via the link.

As the pathology and pain are very multifactorial in nature, we should address the symptoms by managing appropriate load capacity in the shoulder. Biceps tendinopathy commonly occurs alongside rotator cuff tendinopathy or a tear to the rotator cuff tendon. For this reason, a long head of biceps tendinopathy is thought to be the victim to increased loading demands due to the presence of pathology to the rotator cuff complex. An isolated injury to the long head of biceps tendon is extremely uncommon. One exception is an extreme eccentric force to the biceps, leading to a tendon rupture. Like most tendon related injuries, there is typically a component of inflammation and tendon cell degenerative changes. Injuries causing a reactive tendinopathy in the biceps long head are commonly due to doing too much too soon. Activities like lifting weights, and throwing balls such as in cricket or baseball have an increased rate of developing these injuries. However, as mentioned earlier tendinopathies typically result from repetitive overload that exceeds the tendons capacity to tolerate the load.

Long head of biceps tendinopathy symptoms will often present gradually over a period of time. The pain is most commonly located anterior to the shoulder. Pain will occur with overhead movements and there will often be a mild radiation of pain down the bicep muscle to the elbow. Often there will be weakness with movements involving the shoulder and elbow.

The treatment of these injuries involves structured and progressive exercise rehabilitation to the whole shoulder. As the shoulder is multifactorial and complex, we aim to improve the absolute ability of the shoulder to tolerate load through different movements. At The Reform Lab Osteopathy we have the luxury to fully rehabilitate our patients in the elite gym Project Reform.

Ensure you read our informative blog with scientific research ‘Tendon Reaction Injuries’