Biceps Tendinitis: Treatment Options

Biceps Tendinitis: Treatment Options

Left untreated, biceps tendinitis can progress, including continued pain and difficulty with certain everyday tasks like lifting. In addition, the tendon can weaken over time, leading to tearing and may eventually result in a complete rupture of the tendon from its attachment site at the top of the shoulder joint.

Treatment of biceps tendinitis will consider many factors including the patient's age, activity level, and if there are other shoulder conditions that require treatment. Nonsurgical management can be considered for patients who have other shoulder conditions that do not require surgical treatment, or those with mild isolated biceps tendinitis. These treatments include non-steroidal anti-inflammatory medications, possible therapeutic injections, or physical therapy.

For those who do not improve with nonsurgical measures, have other conditions requiring surgery, or those who have sustained a complete rupture of the upper bicep's tendon, surgery is usually recommended. There are 2 main surgical options for treatment of biceps tendinitis. A tenotomy, meaning to cut the tendon, or what is called a tenodesis where the biceps tendon is cut but reattached somewhere else on the upper arm.

In a tenotomy the biceps tendon is cut where it attaches at the top of the shoulder socket and then left alone. The tendon retracts into the upper arm and scars into place. A tenotomy does a great job at relieving the pain from biceps tendinitis, but some may also observe a "Popeye deformity" where the muscle belly balls up in the upper arm. Some patients may also experience weakness or cramping of the biceps muscle.

In a tenodesis, like the tenotomy, the biceps tendon is cut from its attachment site. However, after it is cut, it is reattached somewhere else along the upper arm. The goal is to reestablish the normal amount of tension that is placed on the biceps tendon when it is not injured. This helps to restore the shape of the biceps muscle and may reduce any loss of strength or cramping when compared to a tenotomy.

We will focus on what to expect with a biceps tenodesis procedure for the remainder of this video. Biceps tenodesis can be performed arthroscopically, using a camera called an arthroscope and small incisions called portals. It can also be performed using a mini-open incision located near the armpit. If the surgeon decides to reattach the biceps higher up on the arm, it is likely it will be performed arthroscopically. If they decide to reattach the biceps a bit lower on the upper arm, near the large chest muscle called the pectoralis major, that is when the mini-open incision will be used.

There are a variety of ways to reattach the biceps to the bone, including screws, small anchors, or metal buttons. The type of device used will largely depend on surgeon preference, the location of the reattachment site, and if there are other shoulder conditions being treated.

After surgery for biceps tendinitis, rehabilitation will vary depending on what other repairs in the shoulder were completed. In general, the patient will wear a sling for a period after surgery to protect the reattachment of the biceps tendon. With guidance from the surgeon and a physical therapist, the sling will be discontinued and the patient will start to work on their motion. Gradually, strengthening will be incorporated along with functional movements so the patient can return to their favorite activities.