Overuse injuries can sideline even the most seasoned athlete — learn more about treating biceps tendinitis

Published: September 6, 2023 | Updated: November 4, 2025

The shoulder joint is a complex combination of ligaments, muscles, bones and tendons. All these structures must function correctly to keep the joint in alignment, or the patient could experience pain, decreased range of motion, weakness and discomfort. Athletes in throwing sports must take special care to keep their shoulder healthy or risk developing conditions such as biceps tendinitis.

Overhand throwing is not a natural movement and throwing at speeds up to 90 to 100 mph puts strain and torque on the shoulder, as well as the rest of the arm and can lead to conditions such as biceps tendinitis.

Anatomy of the shoulder

There are three main shoulder bones: the upper arm bone (humerus), shoulder blade (scapula) and collarbone (clavicle). The first two bones make up the ball-and-socket shoulder joint. A series of ligaments, tendons and muscles helps keep the joint aligned holding the ball centered in the shoulder socket.

One muscle in the front of the upper arm is the biceps. The upper end of this muscle is attached to the labrum deep in the shoulder joint by two tendons. One tendon, the long head, is attached to the upper part of the shoulder socket, which is known as the glenoid, while the other tendon attaches to the shoulder blade at the coracoid.

Diagnosing biceps tendinitis

Offseason training and taking good care of the arm throughout the year can help prevent injury.

Thorough examination using diagnostic tests such as MRI, combined with physical examination, is key to diagnosing conditions such as biceps tendinitis.

A physical exam, which includes seemingly unrelated injuries, can reveal a great deal. An unresolved ankle injury, for instance, can throw off other parts of the body.

Biceps tendinitis can emerge if there are issues with the rotator cuff tendons. It also can occur in isolation or in association with arthritis of the shoulder joint, shoulder impingement, chronic shoulder dislocations or a tear in the glenoid labrum, particularly at the biceps attachment site on the upper glenoid.

Treating biceps tendinitis

Sometimes, the biceps can become inflamed, which is called biceps tendinitis. This condition can present as pain at the elbow or in the shoulder.

Initial courses of treatment might include anti-inflammatory medication, stretching, modifying how the athlete throws, physical therapy and possibly other conservative care. Pitchers may need to take time off or throw less.

When nonsurgical interventions fail, the next step might be a surgery such as a tenotomy or a tenodesis. A tenotomy is the intentional severing of the biceps tendon. In a tenodesis, the surgeon cuts the biceps tendon from its attachment in the shoulder joint and reattaches it in a new location on the humerus.