eMedicine Specialties > Sports Medicine > Upper Limb

Bicipital Tendonitis: Follow-up

Author: Britt A Durham, MD, Director of Risk Management, Assistant Professor, Department of Emergency Medicine, King-Drew Medical Center and University of California at Los Angeles; CFO of Durcress Medical Group
Coauthor(s): Richard Chambers, MD, Chief of Orthopedic, Diabetes and Amputee Service, Clinical Associate Professor, Department of Orthopedic Surgery, Rancho Los Amigos Medical Center, University of Southern California
Contributor Information and Disclosures

Updated: Jan 4, 2008

Follow-up

Return to Play

Return to activity should not occur until the patient's discomfort and pain is controlled effectively and a monitoring program has been initiated. Some authors recommend waiting 3 weeks after pain has completely resolved before allowing participation in competitive activities.

Complications

Individuals who return to a high level of athletic activity too soon may find themselves with symptom flare-ups. Continued straining of an injury that has not healed completely can put the individual at risk for chronic degenerative tissue damage and biceps tendon rupture.

Prevention

Prevention of bicipital tendinitis is similar to prevention of rotator cuff injuries, including warm-ups before exercise, the use of passive stretching and strengthening exercises, avoidance of painful activities, and the use of proper biomechanics. Increased attention should be made for those athletes at high risk of bicipital tendinitis, such as baseball pitchers. High angular velocity and torques combined with the repetitious nature of pitching results in vulnerability of the shoulder to injury.

Prognosis

Although the prognosis of bicipital tendinitis is dependent upon the degree of injury, most patients do well with treatment (see Treatment: Acute Phase, Recovery Phase, Maintenance Phase, and Surgical Intervention). However, a significant number of patients develop degenerative changes, and spontaneous rupture of the biceps tendon occurs in 10% of patients.

Education

Inform the patient that an increased risk of biceps tendon rupture or chronic inflammatory changes exists if the directed restrictions are not followed.

Miscellaneous

Medicolegal Pitfalls

  • The risks and benefits of therapy as well as alternative treatments and procedures should be discussed with patients in advance. Although most individuals easily tolerate a rupture of the biceps tendon, an athlete could lose a competitive edge in his/her sport.
  • Failure to advise patients of the increased risk of (1) a biceps tendon rupture from the direct trauma of an accidental steroid injection into the tendon or (2) atrophy that results from multiple injections may place the physician at risk because of failure to obtain appropriate written informed consent.
  • Failure to recognize bicipital tendinitis may result in tendon rupture or chronic degenerative changes, which theoretically could be preventable with appropriate therapy.
  • Tennis players are an example of athletes who often present with simultaneous injuries. As many as one third of tennis players who present with shoulder injuries have additional pathology in the ipsilateral elbow and the neck. Failure to modify physical therapy and medical treatment to take these concomitant conditions into consideration may aggravate the coexisting injuries. Likewise, misdiagnosis may result in the use of therapy that may exacerbate other lesions and also create a delay in the appropriate treatment.

Special Concerns

  • Patients who are receiving repetitive injections and those who are older than 40 years are at an increased risk of complications. Inform the patient of these potential complications before performing any procedures.
 


More on Bicipital Tendonitis

Overview: Bicipital Tendonitis
Differential Diagnoses & Workup: Bicipital Tendonitis
Treatment & Medication: Bicipital Tendonitis
Follow-up: Bicipital Tendonitis
References
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References

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Further Reading

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Keywords

bicipital tendinitis, biceps tendinitis/tendonitis, attrition tendinitis/tendonitis of the biceps

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Contributor Information and Disclosures

Author

Britt A Durham, MD, Director of Risk Management, Assistant Professor, Department of Emergency Medicine, King-Drew Medical Center and University of California at Los Angeles; CFO of Durcress Medical Group
Britt A Durham, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Richard Chambers, MD, Chief of Orthopedic, Diabetes and Amputee Service, Clinical Associate Professor, Department of Orthopedic Surgery, Rancho Los Amigos Medical Center, University of Southern California
Richard Chambers, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Diabetes Association, American Orthopaedic Foot and Ankle Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

David T Bernhardt, MD, Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics, University of Wisconsin
David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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