Shoulder pain in the area of the biceps tendon

Do you suffer from frequent or permanent pain in your shoulder? You cannot lift your arm above your head when you want to comb your hair?

Shoulder pain, which causes you problems in the morning when you dress up or comb your hair, can be caused by of the muscle on the front side of the arm, where it is attached to the biceps muscle and to the supraglenoid tubercle on the shoulder blade.


Biceps and its tendon are often disabled by tendinosis - degenerative disability of the tendon or by tendinitis - inflammation of the tendon. Illness of the tendons is the most common disorder of the soft tissues, with which we meet in practice, and thanks to modern physiotherapeutic methods we can offer you effective solution.

Short term and long term overloading of the muscle, for example during sport, one sided work, incorrect training, etc… is manifested by swelling which doesn’t have to be visible by a naked eye, and subsequently the area is poorly blood supplied, which can lead to ischemic inflammation. Inflammation is then manifested by pain in the whole shoulder and the affected area is warmer on touch. The pain can be also evoked by bending the elbow or lifting the arm up, which is also often accompanied by cracking sound. Problems can be caused also by moving the arm backwards, for example attaching bra, scratching back etc…

These problems are most often troubling athletes; tennis players or volleyball players overload their muscles by fast and hard hits into the ball, it is similar to hard impacts on hands in gymnastics. Also people who work in an incorrect position. Among risky professions are waiters who hold their arm in a position with bending wrist and elbow and shoulder joint. This position is overloading the biceps, which leads to development of swelling and the lasting pressure may even grow into inflammation.

The effect on formation of the problems in the biceps has also the quality of muscle involvement around the shoulder blade and stabilizing muscles of the trunk and nape.


During examination with medical ultrasound there is a visible swelling in the soft tissues, alternatively also inflammation, which can be differed with this method from a degenerative cause of the pain in the shoulder joint or injury of the soft tissues etc…

For a precise diagnosis we use specific tests, which help us to reveal the mobility of the joint or provocation of the pain, which determines more precisely the cause of the pain.


Acute phase

Acute illness appears after one sided demanding stereotypical work and inflammation of the soft tissues is prevailing. Acute phase is manifested by permanent pain even in a peaceful regime,
swelling and increased temperature, sometimes even by redness.

In this phase it is recommended to keep a peaceful regime. Doctors prescribe ointments and drugs to lower painfulness and inflammation.

If the client is recommended to visit a physiotherapist, the therapy usually involves release of of the soft tissues and trigger point in the area of the chest muscle, biceps, triceps and area around the shoulder blade, nape and muscle of the trunk. Trigger points and increased muscle tension protects the shoulder joint from any further damage and pain. Physiotherapist should focus also on functional changes in the area of the spine, ribs, shoulder blades, joints of the arm and hand. „Joint blockages” affect the general mobility of the shoulder girdle. It is optional to use functional tape (flexible cotton band) after each therapy to prolong the effect of the therapy.

After the acute manifestations fade away, it is important to keep the range of the movement of the whole shoulder girdle and involvement of the affected muscle into functional muscle coordinations and common daily activity. It is necessary to restore the stability and the maximal movement range; which can be achieved by techniques such as Vojta method, PNF, Brunkow. It is a holistic approach using therapeutic procedures on a neurophysiological base, as it is used in a modern physiotherapy.

Stretching the front side of the shoulderStretching Biceps

Therapy is effective only when the arm is able to be involved into all movements, which you are used to perform, so that there would be no restrictions. The most modern and at the same the fastest option of treatment is therapy combined with shockwave therapy. In the therapy we use various devices and modern techniques, so we can avoid unpleasant and not always necessary surgery, and at the same time you will enjoy your treatment.

Chronic phase

Chronic illness appears usually in case of incorrect treatment of the acute painful phase or during long lasting one sided burden, which can slowly develop into degeneration of the soft structures and shoulder joint. Symptoms can manifest as a pain during and after physical burden, the area is painful on touch. The usual therapy is long and painful. It is not always possible to restore the original range of movement of the joint, and in some cases the affected people are even offered surgical treatment. This can be prevented with timely started focused shockwave therapy.


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This treatment uses high-energy focused shock wave, which is applied directly into the problematic area, where it can affect the source of the pain (inflammation, trigger point) and start the natural repairing process in the cells. The effect is immediate and permanent, because it deals directly with the cause of the pain.

The pain will subdue already after the first application, during the night the shoulder joint stops to hurt and the movement ability is being gradually restored. To get a fast result, it is ideal to combine focused shock wave therapy with physiotherapy.

Exercise instructions:

 Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic

Source: P. KOLÁŘ et al., Rehabilitace v klinické praxi, Galén, Praha, 2012. ISBN: 978-80-7262-657-1; Clinical experience in diagnosing and therapy with focused shock wave.

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