Biceps Tendonitis:
Common Conditions We Treat (and Why They Happen)
The biceps muscle runs along the front of the upper arm and attaches to the shoulder via two tendons at the top and to the forearm via one tendon at the bottom. It plays a central role in bending the elbow, rotating the forearm, and helping to stabilize and move the shoulder joint. Because the biceps is involved in such a wide range of daily and athletic movements—lifting, pulling, carrying, throwing, and reaching—its tendons are frequently exposed to repetitive stress. When that stress accumulates faster than the tendons can recover, inflammation and irritation develop, producing the condition known as biceps tendonitis.
Proximal Biceps Tendonitis (Shoulder End)
The most common form of biceps tendonitis affects the long head of the biceps tendon, which runs through a groove at the front of the shoulder (the bicipital groove) before attaching inside the shoulder joint. This tendon is particularly vulnerable because of its position—it passes through a confined space and is subject to both friction from the surrounding bony groove and impingement from the structures above it. Patients typically experience a deep, aching pain at the front of the shoulder that worsens with overhead activity, lifting, or reaching across the body, and may notice tenderness when pressing directly on the bicipital groove.
Distal Biceps Tendonitis (Elbow End)
Less common but equally significant, distal biceps tendonitis involves irritation at the point where the biceps tendon inserts onto the radius bone just below the elbow. It typically develops from repetitive heavy lifting, forceful forearm rotation (such as using a screwdriver or wrench), or sudden eccentric loading—when the muscle is contracting while being forcibly lengthened, as in lowering a heavy weight with control. Pain is located at the front of the elbow and may radiate slightly up or down, worsening with resisted elbow flexion and forearm supination.
The Relationship Between Biceps Tendonitis and Shoulder Impingement
Proximal biceps tendonitis rarely exists in isolation. Because the long head of the biceps tendon travels directly beneath the structures involved in shoulder impingement, it is frequently irritated alongside the rotator cuff tendons. Poor shoulder mechanics—such as a rounded shoulder posture, weak rotator cuff, or tight chest and anterior shoulder musculature—narrow the space through which both the rotator cuff and biceps tendon must move. Treating biceps tendonitis without addressing these mechanical contributors is a common reason the condition persists or recurs.
Tendonitis vs. Tendinopathy vs. Partial Tear
Acute biceps tendonitis involves genuine inflammation and typically responds well to soft tissue treatment and activity modification. Chronic biceps tendinopathy, by contrast, involves degenerative changes within the tendon itself—disorganized collagen fibers, increased vascularity, and tissue that is structurally compromised without the classic signs of inflammation. This distinction matters because tendinopathy does not respond to anti-inflammatory approaches alone and requires progressive mechanical loading to stimulate healthy tissue remodeling. In more significant cases, a partial tear of the biceps tendon can occur, producing a more acute and severe pain episode that may require imaging and a modified management approach.
SLAP Tears and Labral Involvement
The long head of the biceps tendon anchors directly into the superior labrum of the shoulder—the ring of cartilage that deepens the shoulder socket. Repetitive traction or a traumatic event can produce a SLAP tear (Superior Labrum Anterior to Posterior), which involves damage to both the labral attachment and the biceps anchor. SLAP tears produce a deep, poorly localized shoulder pain with clicking or catching sensations and may be difficult to distinguish from isolated biceps tendonitis without a thorough clinical examination. While significant SLAP tears may require surgical intervention, many lower-grade lesions respond well to conservative care that addresses the surrounding mechanics and reduces traction on the biceps anchor.
Occupational and Athletic Risk Factors
Biceps tendonitis is particularly common in overhead athletes (swimmers, baseball pitchers, tennis players), weightlifters, and those whose work involves repetitive lifting or carrying. However, it is also seen frequently in sedentary individuals who take on an unusual bout of activity—a weekend of heavy yard work or helping someone move—that their tendons were not conditioned to handle. The combination of volume, intensity, and tissue readiness is what determines risk, regardless of fitness level or age.
The Bottom Line
Biceps tendonitis is a highly treatable condition when approached correctly—but it is also one that tends to linger when only the painful tendon is targeted. Lasting resolution requires identifying and correcting the shoulder mechanics, postural habits, and muscular imbalances that placed the tendon under excessive stress in the first place. Soft tissue therapy to reduce tension in the anterior shoulder and surrounding musculature, combined with chiropractic care to restore proper shoulder joint mechanics and a graduated loading program to rebuild tendon resilience, produces the best outcomes for both acute and chronic presentations.
Triceps Tendonitis:
Common Conditions We Treat (and Why They Happen)
The triceps muscle runs along the back of the upper arm and is the primary muscle responsible for extending the elbow—straightening the arm from a bent position. It also plays an important stabilizing role at the shoulder, particularly during pushing and pressing movements. The triceps tendon attaches to the olecranon process, the bony point at the back of the elbow, and it is at or near this attachment that triceps tendonitis most commonly develops. While it is less frequently discussed than conditions like biceps tendonitis or lateral epicondylitis, triceps tendonitis can be significantly limiting and is often slow to resolve when the underlying causes are not properly addressed.
How Triceps Tendonitis Develops
The triceps tendon is most stressed during activities that require forceful or repetitive elbow extension against resistance—overhead pressing, push-ups, dips, throwing, and any activity that involves rapid or loaded straightening of the arm. When the volume or intensity of these activities exceeds the tendon’s capacity to recover, cumulative microdamage accumulates at the insertion site, triggering an inflammatory response and eventually degenerative changes within the tendon tissue. The condition develops gradually in most cases, with patients often noticing increasing pain at the back of the elbow during and after training that eventually begins to affect everyday movements like pushing open a door or rising from a chair using the arms.
Insertional Triceps Tendinopathy
The most common presentation of triceps tendon pathology is insertional tendinopathy—degeneration and irritation directly at the point where the tendon meets the olecranon. This area is subject to both tensile stress from the pulling force of the muscle and compressive stress where the tendon wraps around the tip of the elbow, particularly in positions of deep elbow flexion. Patients describe a localized aching and tenderness directly on the posterior elbow that is aggravated by pressing movements, pushing off surfaces, and sometimes even by the pressure of resting the elbow on a hard surface.
The Role of Elbow Extension Mechanics
Poor mechanics during pressing and throwing movements are a significant contributor to triceps tendon overload. When the shoulder is not providing adequate stability during a push or press—due to rotator cuff weakness, poor scapular control, or restricted thoracic mobility—the triceps is forced to compensate by generating more force at the elbow. This proximal weakness creating distal overload is a pattern seen throughout the upper extremity, and it means that effective treatment of triceps tendonitis often requires assessment and correction of mechanics well above the elbow itself.
Triceps Tendonitis vs. Olecranon Bursitis
The olecranon bursa—a small fluid-filled sac that cushions the tip of the elbow—sits directly adjacent to the triceps tendon insertion and can become inflamed either from repetitive pressure (leaning on the elbow), direct trauma, or in association with tendon irritation. Olecranon bursitis produces visible swelling at the back of the elbow that can be dramatic even when pain is relatively mild. Distinguishing between bursitis and tendinopathy—or recognizing when both are present simultaneously—is important because each responds to different aspects of treatment. Bursitis with significant swelling and warmth may also require evaluation to rule out infection, particularly if there was a preceding skin abrasion over the area.
Systemic and Pharmacological Contributors
Certain systemic factors increase the risk of triceps—and all—tendon pathology. Fluoroquinolone antibiotics (such as ciprofloxacin) are well-documented to increase tendon fragility and rupture risk and should be a consideration when tendon problems develop unexpectedly or without a clear mechanical cause. Anabolic steroid use dramatically increases rupture risk by stimulating disproportionate muscle hypertrophy without equivalent tendon adaptation. Metabolic conditions including diabetes, hypercholesterolemia, and thyroid dysfunction also impair tendon health and healing capacity and are worth considering in patients whose tendonitis is unusually resistant to treatment.
The Bottom Line
Triceps tendonitis is frequently under treated because it lacks the name recognition of other elbow conditions, and patients often push through the early warning signs until the tendon is significantly compromised. Early intervention with targeted soft tissue therapy to reduce tension at the insertion, combined with chiropractic assessment of the elbow, shoulder, and thoracic mechanics that drive the overload, produces the fastest and most durable results. A progressive loading program to restore tendon capacity—rather than simply resting until pain subsides—is the key to preventing the recurrence that makes this condition so frustrating when managed passively.