Biceps Brachii Trigger Points

Introduction

The biceps brachii is a powerful muscle responsible for elbow flexion, forearm supination, and shoulder stability. When trigger points develop in this muscle, they can cause pain in the front of the shoulder, upper arm, and elbow, often mimicking bicipital tendinitis, rotator cuff injuries, or nerve compression syndromes.

Name and Area

  • Name: Biceps Brachii

  • Area: Located in the anterior upper arm, running from the scapula to the radius with two distinct heads:

    • Long Head: Attaches to the supraglenoid tubercle of the scapula, running through the bicipital groove.

    • Short Head: Attaches to the coracoid process of the scapula.

    • Insertion: Both heads merge into a single tendon that inserts into the radial tuberosity and bicipital aponeurosis.

Indications

Biceps brachii trigger points may contribute to:

  • Pain in the Front of the Shoulder and Upper Arm

  • Pain Extending to the Elbow (Anterior Elbow Pain)

  • Weakness in Elbow Flexion or Forearm Supination

  • Pain When Lifting, Pulling, or Carrying Objects

  • Clicking or Popping Sensation in the Shoulder with Movement

  • Pain That Increases with Overhead Activities (E.g., Throwing, Reaching, or Swimming)

Pain from this muscle is often mistaken for biceps tendinitis or shoulder impingement syndrome.

Muscle Action

  • Elbow Flexion: Bends the elbow, bringing the forearm toward the shoulder.

  • Forearm Supination: Rotates the forearm, turning the palm upward.

  • Shoulder Flexion (Assists): Helps lift the arm forward.

  • Shoulder Stabilization: Supports shoulder positioning during movement.

The biceps brachii plays a crucial role in grip strength, lifting, and functional upper limb movement.

Signs and Symptoms

Individuals with biceps brachii trigger points often report:

  • Deep, Aching Pain in the Front of the Shoulder or Arm

  • Pain That Travels Down to the Elbow or Forearm

  • Tenderness in the Bicipital Groove (Long Head of the Biceps)

  • Weakness in Lifting or Carrying Objects (Due to Elbow or Shoulder Discomfort)

  • Pain When Rotating the Forearm (Turning a Screwdriver or Doorknob)

  • Clicking or Catching Sensation in the Shoulder During Overhead Movements

Pain worsens with repetitive lifting, pulling, or throwing motions.

Perpetuating Factors

Common causes of biceps brachii trigger points include:

  • Repetitive Lifting (Weightlifting, Moving Heavy Objects, Pull-Ups)

  • Overhead Sports (Swimming, Baseball, Tennis, Volleyball)

  • Excessive Forearm Rotation (Using Tools, Driving, Typing for Long Periods)

  • Shoulder Instability or Poor Posture (Rounded Shoulders, Forward Head Position)

  • Carrying Heavy Bags or Backpacks on One Shoulder

  • Sleeping with the Arm in an Overhead Position

Trigger Point Referral Pattern

Trigger points in the biceps brachii refer pain to:

  • The front of the shoulder (Especially in the Bicipital Groove)

  • The front of the upper arm

  • The elbow crease (Anterior Cubital Fossa)

  • The forearm, mimicking nerve entrapment pain

Pain is often mistaken for biceps tendinitis, brachial plexus compression, or nerve-related conditions.

Differential Diagnosis

Biceps brachii trigger points may be mistaken for:

  • Bicipital Tendinitis (Pain in the Bicipital Groove and Shoulder Weakness)

  • Rotator Cuff Injuries (Pain with Overhead Movements, Shoulder Instability)

  • Cervical Radiculopathy (Pain Radiating from the Neck to the Arm and Hand)

  • Brachialis or Brachioradialis Trigger Points (Similar Forearm and Elbow Pain Patterns)

  • Tennis Elbow (Lateral Epicondylitis – Outer Elbow Pain, Not Anterior Pain)

A thorough shoulder and elbow assessment is crucial for correct diagnosis.

Associated Trigger Points

Biceps brachii trigger points often co-exist with:

  • Brachialis (Elbow and Forearm Pain During Flexion Movements)

  • Coracobrachialis (Pain in the Upper Arm and Shoulder Instability)

  • Rotator Cuff Muscles (Pain and Weakness with Overhead Movements)

  • Triceps Brachii (Posterior Shoulder and Elbow Pain When Extending the Arm)

Anatomy and Innervation

The biceps brachii receives motor control from the musculocutaneous nerve, which also innervates the brachialis and coracobrachialis.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules in the bicipital groove and upper arm.

  • Resisted Elbow Flexion Testing: Assess pain and weakness when bending the elbow against resistance.

  • Forearm Supination Testing: Evaluate discomfort when rotating the forearm.

  • Shoulder Stability and Overhead Testing: Check for pain when lifting the arm forward or overhead.

Corrective Actions

Manual Therapy

  • Trigger Point Release: Apply firm pressure along the bicipital groove and muscle belly.

  • Myofascial Release: Stretch and mobilize surrounding shoulder and arm muscles.

Stretching

  • Elbow Extension Stretch: Extend the arm backward with the palm facing up to stretch the biceps and forearm flexors.

  • Shoulder Flexion Stretch: Reach overhead with the opposite arm assisting to stretch the biceps and anterior shoulder.

Strengthening Exercises

  • Eccentric Biceps Curls: Strengthens the biceps while reducing muscle tension.

  • Scapular Retraction Exercises: Improves shoulder stability and posture.

  • Grip Strength Drills: Enhances forearm endurance and function.

Postural and Ergonomic Adjustments

  • Modify Overhead Lifting Techniques (Reduce Strain on the Shoulder and Elbow)

  • Improve Desk Ergonomics (Avoid Excessive Forearm Pronation or Supination)

  • Use Supportive Shoulder Braces During High-Impact Activities

Muscle Origin Insertion Innervation
Biceps Brachii (Long Head) Supraglenoid tubercle of the scapula Radial tuberosity, bicipital aponeurosis Musculocutaneous nerve (C5–C6)
Biceps Brachii (Short Head) Coracoid process of the scapula Radial tuberosity, bicipital aponeurosis Musculocutaneous nerve (C5–C6)
Field Details
Name & Area Biceps Brachii; Upper arm, spanning shoulder to forearm
Indications Shoulder and upper arm pain, elbow discomfort, grip weakness
Muscle Action Elbow flexion, forearm supination, shoulder flexion and stabilization
Signs & Symptoms Pain in the front of the shoulder, weakness in lifting, discomfort during supination
Perpetuating Factors Repetitive lifting, overhead sports, excessive forearm rotation, poor posture
Trigger Point Referral Anterior shoulder, upper arm, elbow crease, forearm
Differential Diagnosis Biceps tendinitis, rotator cuff injury, nerve compression, brachialis trigger points
Anatomy & Innervation Musculocutaneous nerve (C5–C6)
Corrective Actions Manual therapy, stretching, strengthening, ergonomic changes

Summary Table: Biceps Brachii Trigger Points

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.