Biceps Tendon Pain: The Hidden Culprit Behind Shoulder and Elbow Issues

When it comes to upper limb pain, we often blame the shoulder or elbow—but there’s a lesser-known structure that plays a pivotal role in both: the biceps tendon. Whether you’re experiencing a deep ache at the front of your shoulder, sharp pain during lifting, or a clicking sensation with movement, your biceps tendon could be the source.

Biceps tendon injuries are common, underdiagnosed, and frequently mislabelled as rotator cuff tears or general "shoulder strain." But with accurate diagnosis and modern treatment—including regenerative options—patients can avoid unnecessary surgery and recover fully with targeted care.

At MSK Doctors, we take a precision approach to biceps-related pain using advanced diagnostics like onMRI™, ultrasound, and motion analysis, ensuring you receive the right treatment the first time.

Understanding the Biceps Tendon

The biceps muscle has two tendons:

• Long head of the biceps (LHB) – runs through the shoulder joint and attaches to the top of the glenoid (shoulder socket)

• Short head of the biceps – attaches to the coracoid process, outside the joint

The long head is the most common source of pain, due to its vulnerable path through the shoulder and its role in stabilising the joint during overhead movement.

Causes of Biceps Tendon Pain

Biceps tendon pain is often due to overuse, degeneration, or mechanical impingement—especially in athletes, manual workers, or anyone performing repetitive lifting or overhead tasks.

Common causes include:

• Tendinopathy – chronic overuse leading to tendon thickening and pain

• Tendonitis – acute inflammation, often linked to a sudden increase in load

• Tendon tear – partial or complete tear, often associated with rotator cuff damage

• Subluxation or instability – tendon slips out of the groove due to ligament laxity or trauma

• Labral tear (SLAP lesion) – superior labrum injury affecting the biceps anchor

Key Symptoms to Watch For

Biceps tendon issues may mimic rotator cuff or labral injuries, so clinical testing and imaging are crucial. Common symptoms include:

• Sharp pain at the front of the shoulder

• Pain with overhead lifting or biceps curls

• Clicking or popping in the shoulder

• Weakness or fatigue with elbow flexion or forearm rotation

• Tenderness over the bicipital groove (top of the humerus)

• Pain during push-ups or pressing movements

If the tendon ruptures completely, you may notice a visible "Popeye deformity"—a bulge in the upper arm due to retraction of the muscle belly.

When Elbow Pain Is Really Shoulder-Driven

In many cases, elbow pain during curls, gripping, or lifting is actually referred from the proximal biceps tendon or shoulder mechanics. This is why treatments targeting only the elbow often fail when the root cause lies higher up.

Using MAI-Motion™, we analyse shoulder and elbow kinematics in real time to identify faulty patterns—such as scapular dyskinesis or internal impingement—that stress the biceps tendon unnecessarily.

Diagnosis: Imaging and Motion Analysis

Accurate diagnosis is the foundation of effective treatment. At MSK Doctors, we combine:

• onMRI™ – high-resolution MRI with AI-guided segmentation to visualise tendon quality, inflammation, and tears

• Ultrasound – dynamic imaging to assess biceps tendon movement, thickening, or dislocation

• MAI-Motion™ – advanced motion analysis to identify biomechanical overload patterns

These tools help us distinguish between tendonitis, tendinopathy, tears, and instability, guiding your personalised care plan.

Treatment Options: Repair, Rehab, or Regenerate?

✅ Rehabilitation & Biomechanical Correction

Best for: Mild tendonitis, early-stage tendinopathy

• Targeted shoulder and scapular control exercises

• Stretching of tight pecs and posterior capsule

• Rotator cuff strengthening to reduce biceps load

• Postural correction and movement retraining

✅ Cryo-Ultrasound or Shockwave Therapy

Best for: Inflammatory cases or early degenerative changes

• Reduces inflammation and pain

• Promotes tendon healing and circulation

• Painless, non-invasive, in-clinic treatment

✅ Regenerative Injections (PRP or mFAT)

Best for: Partial tears, chronic tendinopathy, failed rehab

• Stimulate natural healing of degenerated tendon tissue

• Injected under ultrasound guidance for precision

• Often avoids the need for surgery

✅ Surgical Intervention

Best for: Complete ruptures, severe instability, failed conservative care

• Biceps tenodesis (re-anchoring the tendon outside the joint)

• Debridement or repair of associated labral tears

• Arthroscopic techniques for quicker recovery

Surgery is rare unless the tendon is fully torn or causing significant mechanical dysfunction.

Preventing Recurrence

Once healed, preventing re-injury is crucial. Our Post-Rehab Return-to-Performance Protocol includes:

• Gradual load reintroduction

• Functional strength training

• Sport-specific shoulder conditioning

• Motion tracking and wearable feedback tools

This ensures you don’t fall back into the same faulty movement habits that caused the problem in the first place.

Frequently Asked Questions (FAQs)

1. How long does biceps tendon pain take to heal?
Mild cases improve in 4–8 weeks with rehab. Chronic tendinopathy may take 3–6 months. Regenerative treatments can accelerate healing.

2. Can I keep training with biceps tendon pain?
You may need to modify or pause certain movements (e.g. curls, presses), but you can usually stay active with professional guidance.

3. Will a biceps tendon tear heal on its own?
Partial tears may heal with rehab and biologics. Complete tears do not heal and may require surgical fixation.

4. Is PRP safe and effective for biceps injuries?
Yes. PRP is safe, minimally invasive, and has shown good outcomes in treating chronic tendon injuries—especially when combined with structured rehab.

5. Can elbow pain be caused by the biceps tendon?
Absolutely. The biceps crosses both the shoulder and elbow. Pain at the front of the elbow may originate from tendon overload or shoulder mechanics.

6. When should I see a specialist?
If pain persists beyond 3–4 weeks, affects your training, work, or sleep—or if you suspect a tear—it’s time for an expert assessment.

Conclusion: Reclaim Your Strength and Shoulder Confidence

Biceps tendon pain may be hidden, but it’s a common and treatable source of upper limb dysfunction. Whether your pain is from overuse, a tear, or poor biomechanics, there’s no need to wait until it becomes disabling.

At MSK Doctors, we combine advanced diagnostics, expert care, and regenerative solutions to restore function and prevent recurrence—without long waiting lists or referral delays.

Book your shoulder or elbow consultation today—and take the first step back to strength.