The biceps as the name suggests has two heads which arise as tendons at the top end in the shoulder. The ‘long head of biceps’ tendon travels through a groove in the humerus, and curves over the top and attaches to the top of the glenoid (which is the socket of the joint).

This long course of the tendon inside the joint lends it to irritation and inflammation with movement. This presents with pain over the front of the shoulder which can radiate to the arm.

This may present on its own or may be associated with impingement syndrome.

If it progresses, it may lead to rupture of the tendon. Once ruptured, the tendon will retract down the arm causing a change in the shape of the biceps (Popeye sign).

The treatment for biceps tendinitis is usually non-operative with analgesia, rest and activity modification. Steroid injections can be given into the tendon sheath under ultrasound guidance. The few that are resistant to conservative management, may be treated surgically. Surgery is rarely indicated once the tendon ruptures.