Biceps Tendinitis

What is biceps tendinitis?

Biceps tendinitis, also called distal biceps tendonitis, is a result of strain, overuse, or repetitive activity of the elbow. The biceps tendon enables the arm to bend easily at the elbow. Distal biceps tendinitis occurs when injury, inflammation, or degeneration damage the tendon. This condition presents as pain in the front of the elbow. When the distal biceps tendon is injured or diseased, it can cause impairment when flexing the elbow or turning the forearm upward (supination).

Anatomy of the biceps tendon

The biceps is a two-headed muscle that lies on the front of the upper arm between the shoulder and the elbow.

The biceps muscle is one of the chief flexors of the forearm. It bends the elbow and twists the forearm. Two tendons attach the biceps muscle: one to the upper arm and the other to the radius bone at the elbow. The tendon near the elbow is the distal biceps tendon.

Biceps Tindinitis Anatomy

Causes of biceps tendinitis

Biceps tendinitis can be caused by injury or overuse, hyper-extension of the arm, or a sudden increase in intensity of movement. It can also be a result of overuse or moving the arm in a repetitive manner, especially the wrist rotating or the elbow bending. Athletes in sports that require intense, repetitive motions using the elbow (like tennis), doing heavy lifting, or being in poor overall physical condition are at a higher risk of developing the condition.

Symptoms of tendinitis

The key symptoms are pain and tenderness at the front of the elbow. This pain intensifies when the arm is used to lift objects, bend the elbow, or lift the arm upwards. The elbow may also be stiff or sore on the inside, close to the biceps muscle. If the biceps tendon tears from the bone, a popping sound may occur in the front of the elbow and a sharp pain will be felt upon injury. Whether the biceps tendon is partially or completely torn, the arm will feel weak when the elbow is bent.

How is tendinitis of the biceps diagnosed?

Biceps tendinitis is diagnosed with a physical examination along with x-ray and MRI imaging. While x-rays can show bones and joints, MRIs will reveal irregularities in the soft tissue. There are two types of imaging used to diagnose biceps tendinitis. Ultrasonography is used to visualize the overall tendon. Magnetic resonance imaging (or computed tomography arthrography) is the preferred imaging used to visualize the intraarticular tendon and related pathology. In addition to imaging, the physical exam includes the doctor checking for tenderness and range of motion. The stability of the elbow will also be examined.

How is tendinitis of the biceps treated?

Depending on the severity of the condition, biceps tendinitis may be treated non surgically or surgically.

Nonsurgical treatment


Icing the injured area is suggested to reduce inflammation and swelling. Putting ice on the elbow for 20 minutes 3-4 times throughout the day is recommended.


Resting the arm and avoiding activities like lifting or big movements may enable the biceps tendon to heal on its own if it is not torn.


Anti-inflammatory medication like ibuprofen reduces swelling and pain.

Steroid injections

Corticosteroid injections into the biceps tendon sheath will minimize swelling and reduce pain.

Physical Therapy

Stretching and strengthening exercises as well as massage and ultrasound physical therapy treatment can improve flexibility and range of motion.

Surgical treatment


For best results, distal biceps tendinitis surgery should occur within the first three weeks of injury, so that the biceps tear does not begin to scar. The goal of the surgery is to attach the distal biceps again to the bone in the forearm. An incision is made either at the front of the elbow or the front and the back. After drilling a hole in the radius bone, the tendon is attached with stitches and metal implants, which serve as anchors.