Biceps Tendinopathy Treatment & Management

  • Author: Peter Gonzalez, MD; Chief Editor: Robert H Meier III, MD   more...
 
Updated: Nov 29, 2011
 

Rehabilitation Program

Physical Therapy

The components of a physical therapy program, as follows, are coordinated with various stages of the bicipital tendinopathy:

  • Immediate
    • Initiate rest, ice, compression, and elevation (RICE) therapy.
    • Avoid activity that aggravates the condition.
  • Subacute
    • Physical therapy should involve soft-tissue therapy with transverse gliding of the tendon and cross-friction massage.
    • Electrical stimulation and/or ultrasonography may be beneficial if symptoms interfere with therapeutic exercise.
    • Apply moist heat to help facilitate stretching and reduce pain.
    • If the shoulder is stable, perform ROM exercises for the shoulder, including gradual stretching of the biceps tendon. Other activities include circumduction, pendulum, 2-hand rod swinging, and lateral/front finger wall walking.
    • Progress to resistive exercises as symptoms subside. Isometrics progress to concentric exercises, then to eccentric exercises, and finally to sport-specific exercises. Eccentric loading in the management of tendinopathies of other muscle groups has shown promise in reversing some degenerative changes.[4]
    • Closed kinetic chain exercises are generally started first, with open kinetic chain exercises initiated later with sport-specific activities.
    • Perform proprioceptive shoulder exercises with a Swiss ball.
    • Address biomechanical factors that may be contributing to the biceps tendinopathy.
  • Long term
    • Continue physical therapy as described.
    • Avoid aggravating factors.
    • Look for other causes or predisposing factors, such as bony abnormalities, labral pathology, and radiculopathy.

Occupational Therapy

The occupational therapist should instruct the patient with biceps tendinopathy in the use of the appropriate adaptive equipment, in work simplification strategies, in ergonomic modifications, in the stretching of the appropriate shoulder girdle musculature, and in the strengthening program that will eventually be undertaken.

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Medical Issues/Complications

Possible complications that can develop from biceps tendinopathy include the following:

  • Recurrent anterior shoulder pain
  • Biceps rupture
  • Weakness
  • Maladaptive compensation strategies by the individual, causing other ailments
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Surgical Intervention

  • Surgery is rarely necessary, but it may be required in patients with refractory cases associated with persistent pain that has not responded to any other treatment.[14, 15, 16]
  • Surgery often involves decompression of the musculotendinous structure through tenolysis, using arthroscopic or open surgical technique.[2]
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Other Treatment

  • Injection with anesthetic and corticosteroid into the biceps tendon sheath may be helpful. This can be performed under ultrasonographic guidance to ensure correct placement of the medication.[17] Avoid direct injection into the biceps tendon.
  • Myofascial trigger point injections in the scapular stabilizer muscles may be beneficial. This technique uses an injection with dilute local anesthetic.
  • Manipulation may be helpful, especially for first-rib abnormalities that contribute to the syndrome.
  • Lithotripsy (extracorporeal shock wave therapy) has been under study for Achilles and patellar tendinopathy, with promising results. No studies related to biceps tendinopathy have been published.
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Contributor Information and Disclosures
Author

Peter Gonzalez, MD  Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine

Peter Gonzalez, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Coauthor(s)

Carter H Sigmon, MD, MHA  Resident Physician, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine

Carter H Sigmon, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

William J Sullivan, MD  Associate Professor, Pain Medicine Fellowship Site Director, Director of Medical Student Education, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver Health Sciences Center

William J Sullivan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, International Spine Intervention Society, and North American Spine Society

Disclosure: Nothing to disclose.

Keith Aj Sequeira  MD, FRCPC, Associate Professor, Director of Education, Department of Physical Medicine and Rehabilitation, Parkwood Hospistal, University of Western Ontario

Disclosure: Nothing to disclose.

Patrick J Potter, MD, FRCP(C)  Associate Professor, Department of Physical Medicine and Rehabilitation, University of Western Ontario School of Medicine; Consulting Staff, Department of Physical Medicine and Rehabilitation, St Joseph's Health Care Centre

Patrick J Potter, MD, FRCP(C) is a member of the following medical societies: American Paraplegia Society, Canadian Association of Physical Medicine and Rehabilitation, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert J Kaplan, MD  James E Van Zandt VA Medical Center, Staff Physician, Department of Rehabilitation Medicine

Robert J Kaplan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Patrick M Foye, MD  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Robert H Meier III, MD  Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke's Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital

Robert H Meier III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

References

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