Biceps Tendinitis Treatment Options

What is biceps tendinitis?

Biceps tendinitis refers to inflammation or irritation of the biceps tendon, a strong cord-like structure that connects the biceps muscle to the shoulder or elbow joint. This condition commonly occurs due to overuse or repetitive movements, such as lifting heavy objects or engaging in activities that require repetitive overhead motion. Individuals with biceps tendinitis typically experience pain, tenderness, and swelling in the front of the shoulder or the elbow, depending on the affected tendon. Treatment for biceps tendinitis often involves rest, ice, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy to alleviate symptoms, reduce inflammation, and strengthen the muscles surrounding the affected tendon. In severe cases, corticosteroid injections or surgical intervention may be considered to relieve persistent symptoms and restore function. Early diagnosis and appropriate management are essential to prevent chronicity and optimize outcomes for individuals with biceps tendinitis.

What non-operative treatment options are available?

1. Rest: Rest is a fundamental component of biceps tendinitis management, allowing the inflamed tendon to heal and recover from overuse or repetitive strain. Avoiding activities that exacerbate symptoms, such as heavy lifting or overhead movements, is essential during the acute phase of injury.
2. Ice Therapy: Applying ice packs to the affected area can help reduce pain, swelling, and inflammation associated with biceps tendinitis. Ice therapy is typically recommended for 15-20 minutes several times a day, particularly after activities that may aggravate symptoms.
3. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter NSAIDs, such as ibuprofen or naproxen, may be used to alleviate pain and inflammation associated with biceps tendinitis. These medications should be used cautiously and under the guidance of a healthcare professional, considering potential side effects and contraindications.
4. Physical Therapy: Physical therapy plays a crucial role in the conservative management of biceps tendinitis, focusing on reducing pain, restoring mobility, and strengthening the muscles surrounding the affected tendon. Therapeutic modalities such as ultrasound, electrical stimulation, and manual therapy techniques may be employed to alleviate symptoms and promote healing.
5. Stretching and Strengthening Exercises: Specific stretching and strengthening exercises targeting the biceps, shoulder, and scapular muscles can help improve flexibility, joint stability, and overall function. Eccentric exercises, in which the muscle lengthens while under tension, are particularly effective in rehabilitating the biceps tendon and promoting tendon remodeling.
6. Activity Modification: Modifying activities that aggravate biceps tendinitis symptoms, such as avoiding repetitive overhead motions or using proper lifting techniques, can help prevent further irritation and facilitate recovery. Occupational or sports-specific modifications may be recommended to minimize strain on the affected tendon during daily or recreational activities.
7. Corticosteroid Injections: In cases of persistent or severe biceps tendinitis, corticosteroid injections may be considered to provide short-term pain relief and reduce inflammation. These injections are typically administered under ultrasound or fluoroscopic guidance to ensure accurate placement and minimize the risk of complications.
8. Platelet-Rich Plasma (PRP) Therapy: PRP therapy involves injecting concentrated platelets derived from the patient’s own blood into the affected tendon to promote tissue healing and regeneration. While research on the efficacy of PRP for biceps tendinitis is ongoing, some studies suggest that it may offer symptomatic relief and improve tendon healing in select cases.

What operative treatment options are available?

Biceps tenodesis and tenotomy are surgical procedures performed to address chronic biceps tendinitis, often in cases where conservative treatments have failed to provide adequate relief.

1. In biceps tenodesis, the biceps tendon is surgically detached from its original attachment site in the shoulder and reattached to a different location, typically within the bicipital groove or on the humeral head. This procedure aims to alleviate pain and restore function while preserving the length-tension relationship of the biceps muscle.
2. Biceps tenotomy involves complete surgical release of the biceps tendon from its attachment site, effectively removing the tendon from the shoulder joint.

While both procedures can provide symptomatic relief, biceps tenodesis is favored in active individuals who require maintenance of biceps function and strength, while tenotomy may be suitable for those less concerned with preserving biceps function or when other shoulder pathology is present. Close collaboration between the patient and Dr. Shane J. Nho is essential in determining the most appropriate surgical approach based on individual patient factors and treatment goals.

What does rehabilitation entail?

Rehabilitation plays a crucial role in the treatment of biceps tendinitis, regardless of whether conservative or interventional measures are employed. A structured rehabilitation program, supervised by Dr. Shane J. Nho and a qualified physical therapist, focuses on restoring joint mobility, improving muscle strength and endurance, and addressing any underlying biomechanical imbalances contributing to tendon irritation.

1. Early Phase (0-6 weeks): In the acute phase of biceps tendinitis treatment, the focus is on pain management, reducing inflammation, and promoting tissue healing. Physical therapy interventions may include gentle range of motion exercises, modalities such as ice or heat therapy, and manual techniques to alleviate muscle tightness and joint stiffness.
2. Intermediate Phase (6-12 weeks): As symptoms subside and tissue healing progresses, rehabilitation advances to include progressive strengthening exercises targeting the biceps, shoulder, and scapular muscles. Eccentric exercises, plyometric drills, and sport-specific training may be incorporated to improve functional capacity and prepare the patient for a gradual return to activity.
3. Advanced Phase (12 weeks and beyond): In the final phase of rehabilitation, the emphasis shifts towards optimizing joint stability, neuromuscular control, and overall functional performance. Advanced strengthening exercises, proprioceptive training, and agility drills are introduced to simulate dynamic movements and challenges encountered during daily or recreational activities.

What does return to activity look like?

The timing of return to activity following biceps tendinitis treatment varies depending on the individual patient’s response to treatment, severity of symptoms, and underlying biomechanical factors. In general, a gradual and phased approach to activity progression is recommended to minimize the risk of re-injury and ensure long-term success. Close communication between the patient, Dr. Shane J. Nho, and their physical therapist is essential to establish realistic goals, monitor progress, and address any concerns or setbacks during the rehabilitation process.

Dr. Shane J. Nho is a board-certified fellowship trained sports medicine orthopaedic surgeon who specializes in the treatment of biceps tendinitis. If you believe you are affected by biceps tendinitis, schedule a consultation today with our experienced orthopaedic care team.