Bicipital Tendonitis Follow-up
- Author: Britt A Durham, MD; Chief Editor: Sherwin SW Ho, MD more...
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.
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 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.
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.
Inform the patient that an increased risk of biceps tendon rupture or chronic inflammatory changes exists if the directed restrictions are not followed.
Ahrens PM, Boileau P. The long head of biceps and associated tendinopathy. J Bone Joint Surg Br. 2007 Aug. 89(8):1001-9. [Medline].
Safran MR, McKaeg DB, Van Camp SP, eds. Biceps tendon injuries. Manual of Sports Medicine. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998. 347-9.
Nicholis JA, Hershman EB, eds. Bicipital tendinitis. The Upper Extremity in Sports Medicine. 2nd ed. St. Louis, Mo: Mosby; 1995. 303-6.
Rockwood CA Jr, Matsen FA II, eds. The Shoulder. Philadelphia, Pa: WB Saunders; 1990. 810-21.
Murtagh J. Bicipital tendinitis. Aust Fam Physician. 1991 Jun. 20(6):817. [Medline].
Singaraju VM, Kang RW, Yanke AB, McNickle AG, Lewis PB, Wang VM, et al. Biceps tendinitis in chronic rotator cuff tears: a histologic perspective. J Shoulder Elbow Surg. 2008 Nov-Dec. 17(6):898-904. [Medline].
Patton WC, McCluskey GM 3rd. Biceps tendinitis and subluxation. Clin Sports Med. 2001 Jul. 20(3):505-29. [Medline].
Ellenbecker TS. Rehabilitation of shoulder and elbow injuries in tennis players. Clin Sports Med. 1995 Jan. 14(1):87-110. [Medline].
Ouellette H, Labis J, Bredella M, et al. Spectrum of shoulder injuries in the baseball pitcher. Skeletal Radiol. 2007 Oct 3. Epub ahead of print. [Medline].
Hadala M, Barrios C. Sports injuries in an America's Cup yachting crew: A 4-year epidemiological study covering the 2007 challenge. J Sports Sci. 2009 May. 27(7):711-7. [Medline].
Kim KC, Rhee KJ, Shin HD, Kim YM. A SLAP lesion associated with calcific tendinitis of the long head of the biceps brachii at its origin. Knee Surg Sports Traumatol Arthrosc. 2007 Dec. 15(12):1478-81. [Medline].
Churgay CA. Diagnosis and treatment of biceps tendinitis and tendinosis. Am Fam Physician. 2009 Sep 1. 80(5):470-6. [Medline].
Onga T, Yamamoto T, Akisue T, Marui T, Kurosaka M. Biceps tendinitis caused by an osteochondroma in the bicipital groove: a rare cause of shoulder pain in a baseball player. Clin Orthop Relat Res. 2005 Feb. 431:241-4. [Medline].
Streit JJ, Shishani Y, Rodgers M, Gobezie R. Tendinopathy of the long head of the biceps tendon: histopathologic analysis of the extra-articular biceps tendon and tenosynovium. Open Access J Sports Med. 2015. 6:63-70. [Medline].
Gaskin CM, Anderson MW, Choudhri A, Diduch DR. Focal partial tears of the long head of the biceps brachii tendon at the entrance to the bicipital groove: MR imaging findings, surgical correlation, and clinical significance. Skeletal Radiol. 2009 Oct. 38(10):959-65. [Medline].
Buck FM, Grehn H, Hilbe M, et al. Degeneration of the long biceps tendon: comparison of MRI with gross anatomy and histology. AJR Am J Roentgenol. 2009 Nov. 193(5):1367-75. [Medline].
Carr RM, Shishani Y, Gobezie R. How Accurate Are We in Detecting Biceps Tendinopathy?. Clin Sports Med. 2016 Jan. 35 (1):47-55. [Medline].
Lecoq B, Levasseur R, Fournier L, Schmutz G, Marcelli C. Atypical pattern of acute severe shoulder pain: contribution of sonography. Joint Bone Spine. 2004 Nov. 71(6):592-4. [Medline].
Ardic F, Kahraman Y, Kacar M, et al. Shoulder impingement syndrome: relationships between clinical, functional, and radiologic findings. Am J Phys Med Rehabil. 2006 Jan. 85(1):53-60. [Medline].
Ellman H, Gartsman GM. Arthroscopic Shoulder Surgery and Related Procedures. Philadelphia, Pa: Lea & Febiger; 1993. 243-4.
Skedros JG, Hunt KJ, Pitts TC. Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians. BMC Musculoskelet Disord. 2007 Jul 6. 8:63. [Medline]. [Full Text].
Mitra R, Nguyen A, Stevens KJ. Fluoroscopically guided supraglenoid tubercle steroid injections for the management of biceps tendonitis. Pain Pract. 2011 Jul-Aug. 11(4):392-6. [Medline].
Sethi N, Wright R, Yamaguchi K. Disorders of the long head of the biceps tendon. J Shoulder Elbow Surg. 1999 Nov-Dec. 8(6):644-54. [Medline].
Scully WF, Wilson DJ, Grassbaugh JA, Branstetter JG, Marchant BG, Arrington ED. A simple surgical technique for subpectoral biceps tenodesis using a double-loaded suture anchor. Arthrosc Tech. 2013 May. 2(2):e191-6. [Medline]. [Full Text].
Friedman DJ, Dunn JC, Higgins LD, Warner JJ. Proximal biceps tendon: injuries and management. Sports Med Arthrosc. 2008 Sep. 16(3):162-9. [Medline].
Holtby R, Razmjou H. Accuracy of the Speed's and Yergason's tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Arthroscopy. 2004 Mar. 20(3):231-6. [Medline].
van Tulder M, Malmivaara A, Koes B. Repetitive strain injury. Lancet. 2007 May 26. 369(9575):1815-22. [Medline].