Long Head of Biceps Pain Treatment London | Private Ultrasound Diagnosis & Injections

Long Head of Biceps Tendon Pain Explained

The Long Head of Biceps Anatomy

The biceps muscle is the anatomical name given to the large muscle at the front of the upper arm. Its attachment point below the elbow enables it to be a powerful flexor of the elbow, but it is also anchored above the shoulder joint by two tendons. The first tendon attaches onto a bony prominence known as the coracoid process and is rarely injured. The second tendon attachment runs into the front of the shoulder joint capsule and attaches onto the rim of the shoulder socket. Due to this attachment within the shoulder joint, the long head of biceps tendon and its attachment serve as one of the stabilising mechanisms of the shoulder joint during activities and enable the biceps to assist overhead movements with the palm turned upwards.

Causes of Biceps Tendon Pain at the Shoulder

The long head of biceps is a common site of pain at the front of the shoulder and into the upper arm and may be caused by a variety of degenerative changes to the tendon or acute injuries to the tendon.

Long Head of Biceps Tendon Pathology Diagnosis

Ultrasound imaging is able to visualise the long head of biceps tendon structure from the shoulder capsule through to the myotendinous junction with the muscle bulk, and can also image the muscle bulk with great definition to detect any sites of pathology which may be causing pain.

Specific pathology demonstrated on ultrasound may include degenerative changes to the tendon fibres and degenerative changes to the bicipital groove (also known as the bicipital sulcus), which is the bony groove that the tendon glides within as it exits the shoulder capsule in the upper arm.

In some cases, the long head of biceps tendon may become painful and unstable due to subluxation of the tendon out of this groove. Long head of biceps subluxation can sometimes be missed unless dynamic ultrasound imaging is used.

Long head of biceps tendon ruptures are also a common cause of long-standing or acute shoulder pain and can be easily visualised with ultrasound. Most commonly, these occur at the junction between the lower aspect of the tendon and the muscle fibres at the myotendinous junction, or at the junction of the shoulder capsule.

Tenosynovitis of the long head of biceps tendon is also commonly seen with ultrasound imaging. In these cases, the fibres and tendon body may appear normal, but there may be swelling within the tendon sheath, with fluid present in the sheath. This fluid may originate from the long head of biceps itself or may flow from the shoulder joint.

Long Head of Biceps Tendon Ultrasound Guided Injections

How is a Long Head of Biceps Injection Administered?

In cases of significant long head of biceps tenosynovitis, an ultrasound-guided injection can be administered by placing the ultrasound probe in a transverse plane across the upper arm, visualising the long head of biceps and any fluid within the biceps tendon sheath. The needle can be clearly visualised entering from the near side of the probe and passing into the long head of biceps tendon sheath, after which the injectate is administered.

What to Do After Your Long Head of Biceps Injection

Needle Path & Post-Injection Pain
The long head of the biceps tendon sheath is a relatively deep structure, and the needle needs to pass through a slightly more sensitive area at the front of the shoulder and through the deltoid muscle. As a result, some soreness at the needle path is common and may last for 2–3 days. The needle also penetrates an inflamed tendon sheath, which may contribute to this short-term discomfort.
If this occurs, over-the-counter painkillers (as directed on the patient information leaflet) can be taken.

Post-Injection Flare
There is no significant connection between experiencing a post-injection flare and the needle path itself. However, very rarely, a flare may occur due to the effects of the medication, as previously described.

Wound Care & Infection Risk
Avoid exposing the needle site to public or dirty water (e.g., swimming pools, hot tubs, lakes) for 2–3 days after any ultrasound-guided injection, due to the small infection risk.

Activity Guidance
Following this injection, you can begin gradually loading the biceps tendon and shoulder muscles as part of your rehabilitation. However, you should avoid any significant overhead activity or heavy loading through the shoulder for two weeks after the injection.

Follow-Up
If you experience any unusual pain, swelling, redness, or other concerns following your injection, please contact me immediately for advice.

Other Treatments for Biceps Tendon Pain at the Shoulder

Stretches for Biceps Tendon Pain

Strengthening Exercises for Biceps Tendon Pain

Advanced Strengthening Exercises for Biceps Tendon Pain

Long Head of Biceps Pain | Evidence base

The evidence base for the isolated management of long head of biceps tendinopathy is somewhat limited, as it often coexists with other shoulder pathologies. Nonetheless, conservative management remains the mainstay of treatment. Physiotherapy focused on mobility, rotator cuff strengthening, and direct biceps loading is supported by extrapolated evidence from tendinopathy literature elsewhere in the body. Corticosteroid injections into the bicipital groove may offer short-term analgesia, particularly when inflammation or effusion is present, but carry the usual risks of tendon weakening and should be used sparingly. Surgical options, such as tenotomy or tenodesis, may be effective in chronic, non-responsive cases, particularly in older or athletic populations. However, conservative care is still considered the first step in most clinical guidelines.

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