Orthopaedics and Rehab

Pain in the arm? Tips to heal biceps tendonitis without surgery

Orthopaedics and Rehab

Man lifting box
Biceps pain doesn’t have to be something you live with. Physical therapy and other non-surgical treatments can heal tendonitis in 75% of cases.

Your biceps muscle – the large, thick muscle that runs along the front of your arm – relies on two important tendons to flex and to lift objects overhead. The tendons connect the muscle to the shoulder at two points: the short head and the long head.

These tough, fibrous tissues are designed to withstand tension and stress, and they allow you to move your arm during daily activities. But when you do the same move over and over – such as lifting boxes from the floor to a shelf or focusing just on the biceps in weightlifting – it’s common for the long head of the biceps tendon to become inflamed due to strain or overuse.

This injury is called long head biceps tendinopathy, more commonly known as biceps tendonitis. You likely won’t hear a pop or feel the injury happen. It’s a gradual, wear-and-tear injury that creeps up over time. Biceps tendonitis can cause pain and discomfort in the upper arm when doing everyday tasks along with weakness and stiffness of the shoulder joints.

Many patients put off seeing a health care provider, worrying that they’ll need shoulder surgery – and a lot of downtime – to get pain relief. For some patients, minimally invasive shoulder surgery is appropriate. But with specialized care from the UT Southwestern Physical Medicine and Rehabilitation (PM&R) team and our colleagues in orthopedic care, 75% of patients with biceps tendonitis can avoid surgery and get on the road to recovery.

From spotting the injury to getting physical therapy or injection-based treatments, here’s our guide to healing biceps tendonitis without surgery – and tips to prevent this uncomfortable condition.

When to see a healthcare provider for biceps pain

If you feel intense or acute pain or hear a snap or popping sound, see a medical professional right away. Sudden pain can be a sign of a more serious injury, such as a rotator cuff tear. The earlier you get a diagnosis, the faster you can start treatment.

If your pain has come on gradually, we typically recommend that you wait six weeks to see a provider. In the meantime, take it as easy as possible on activities that exacerbate symptoms, such as lifting objects overhead. Mild cases of tendonitis take about six weeks to naturally heal. If this does not occur, then it’s time to see an orthopedics provider or PM&R specialist.

At your appointment, we’ll ask questions about when you started feeling pain, where it hurts, and what the severity of your pain is. The provider may diagnose you on the spot or order diagnostic imaging such as an MRI to visualize the long head biceps tendon. Depending on your pain level, the severity of the injury, and its effect on your life, we’ll design a plan to fast-track healing and get you back to your regular activities – likely without surgery.

Related reading: Unraveling the mystery — and misery — of frozen shoulder

A well-informed primary care physician assistant can diagnose and initiate treatment, decreasing a patient’s discomfort in an expedited fashion instead of waiting for a referral to an orthopedic provider.

Amanda Ben Simon, MMS, PA-C

Non-surgical interventions for biceps injuries

Most patients will see total relief from symptoms with one or more of these treatments:

  • Physical therapy. Physical therapy is the primary non-surgical intervention for biceps tendonitis. Your physical therapist will guide you through tendon-focused exercises and may recommend therapeutic massage and support with kinesiology tape.
  • Corticosteroid injection: Corticosteroids are commonly used to reduce inflammation and lessen the pain. According to one study, over half (53%) of patients who received a corticosteroid injection recovered completely after 6 weeks.
  • Rest and cold therapy: Getting rest from agitating activities and applying ice for 10 to 15 minutes several times a day can ease inflammation.
  • Anti-inflammatory medication: Over-the-counter medications like ibuprofen can decrease inflammation. However, long-term ibuprofen use does have certain risks, such as ulcers or stomach bleeding. Check with your provider to see if you’re at risk for these conditions. You may also be prescribed alternative anti-inflammatories.

Another possible treatment is platelet-rich plasma therapy. In this treatment, a concentrated form of the patient’s platelets is injected directly into the joint. While one study reported a significant decrease in pain after this therapy, more research is needed before platelet-rich plasma therapy becomes a definitive treatment for biceps tendonitis. Ask your provider whether this treatment may be a good option for you.

If these interventions don’t work and you and your provider decide you do need surgery, you’ll be in good hands at UT Southwestern. Our team of experts has perfected a minimally invasive technique with a shorter recovery time.

Related reading: Biceps tendonitis: How arthroscopic surgery relieves shoulder pain, reduces scarring

Tips to prevent biceps tendonitis

Biceps tendonitis often occurs due to repetitive motions, and changing your routine can help relieve symptoms or prevent the condition. To reduce the risk of developing biceps tendonitis:

  • Listen to your body. You might hear the phrase “push through the pain” in fitness circles, but that mindset can easily lead to injury. Pain is usually a sign from the body that it’s time to slow down and rest.
  • Warm up and stretch. Before a workout or shift at a physical job, warm up with light cardiovascular exercise such as jogging or stepping in place. Then gently stretch the arms and shoulders to improve flexibility and range of motion. If you’re unsure where to start, a physical therapist can help personalize movement to ease your pain.
  • Lift with your legs, not your arms. Many of our patients got injured while lifting something when moving to a new home. If you’re planning a big move, make sure you lift with the strength of your legs, not just with your arms, to limit strain on your biceps.
  • Quit smoking. Research shows that smoking can reduce the blood supply to your biceps. This can worsen recovery time for chronic tendonitis.

Chronic or acute long head biceps tendinopathy can make lifting, reaching, and even brushing your hair a painful exercise. If you feel pain in your biceps, talk with a healthcare provider about your symptoms. We can help design a treatment plan for you and get you back to your regular activities fast.

To talk with a specialist about biceps tendonitis, call 214-645-8300 or request an appointment online.