Biceps Tendonitis: A Pitcher’s Frustration

Overuse and repetitive motion can lead to a lot of common injuries for athletes. For pitchers, this is true for shoulder and arm injuries, especially in the big leagues.

Red Sox lefty Drew Pomeranz was recently placed on the disabled list for biceps tendonitis. “This is a common injury for pitchers who place such high demand on their arms,” says Julie Ruane, a nurse practitioner in the Division of Sports Medicine at BIDMC. “Repetitive motions like throwing at high speeds can cause the tendon to become inflamed and painful.”

Biceps tendonitis is inflammation of the biceps tendon. The biceps muscle has two heads at the shoulder attachment, and one tendon down at the elbow. The long head connects the biceps muscle to the shoulder socket, whereas the short head of the biceps attaches to another part of the shoulder blade along the upper chest. Tendonitis can be especially painful because the tendon sheath, or covering, can become inflamed, thicken and restrict mobility.

“Tenderness, achiness and pain that can radiate over the front of the shoulder and upper arm is common. In the case of a long head biceps tendon rupture or tear, you may feel or hear a pop, or a ‘snapping’ sensation in the upper arm,” Ruane says.

Biceps tendonitis is commonly seen in conjunction with other shoulder conditions, such as injuries to your rotator cuff, shoulder dislocation or osteoarthritis, but oftentimes is simply the result of overuse.

“In many cases, tendonitis may improve simply with rest. Treatments such as ice, an oral anti-inflammatory medication and rehabilitation exercises may also be helpful,” Ruane says. “Tendons have poor blood supply, so they can be slow to heal. Not exactly the best news for an athlete in the middle of a season like Pomeranz.”

In many cases, steroid injections such as cortisone can relieve pain. In the case of biceps tendonitis, however, Ruane says direct injections into the tendon are often avoided. “The steroid can actually weaken the tendon and even lead to rupture. Instead, I encourage my patients to see a physical therapist to focus on range of motion and strengthening the muscles around the shoulder,” she says.

This diagnosis can sometimes be frustrating for athletes who may be tempted to play through the pain. “But the short-term disappointment in taking some time to rest will likely be beneficial in the long-run,” Ruane says.