From the Guidelines
Tendinosis of the infraspinatus, subscapularis, and biceps tendons should be treated with conservative measures, including relative rest, icing, and eccentric strengthening exercises, as approximately 80% of patients fully recover within three to six months 1.
Diagnosis and Treatment
The diagnosis of tendinosis is supported by physical maneuvers that simulate tendon loading and predictably reproduce the patient’s pain, and examination includes inspection for muscle atrophy, asymmetry, swelling, erythema, and joint effusions 1.
- Relative rest is essential to decrease repetitive loading of the damaged tendon 1.
- Icing for 15-20 minutes several times daily can help reduce pain and inflammation.
- Eccentric strengthening exercises, typically 2-3 sessions weekly for 6-8 weeks, are crucial for promoting proper tendon remodeling.
- Corticosteroid injections may be considered if pain persists after 4-6 weeks of conservative treatment, though these should be limited to 2-3 injections per year.
Surgical Options
If conservative measures fail after 3-6 months, surgical options like tendon debridement or repair might be necessary, as surgery is an effective treatment option in carefully selected patients 1.
- Surgical techniques vary by tendinopathy location but typically include excision of abnormal tendon tissue and performance of longitudinal tenotomies to release areas of scarring and fibrosis.
Quality of Life
Maintaining proper shoulder positioning with a supportive pillow can help reduce nighttime pain, and activity modification is crucial - avoid overhead movements, heavy lifting, and repetitive shoulder activities until symptoms improve.
- Approximately 80% of patients with overuse tendinopathies fully recover within three to six months, and outpatient treatment should consist of relative rest of the affected area, icing, and eccentric strengthening exercises 1.
From the Research
Tendinosis of the Infraspinatus, Subscapularis, and Biceps Tendons
- Tendinosis of the infraspinatus, subscapularis, and biceps tendons can be caused by various factors, including degeneration of the tendon from athletics requiring overhead motion or from the normal aging process 2.
- Infraspinatus tendon pathology, ranging from tendinosis to full-thickness tears, is significantly correlated with supraspinatus muscle atrophy 3.
- Subscapularis tendon pathologies do not show a similar correlation with supraspinatus muscle atrophy, but partial subscapularis tears can affect the supraspinatus muscle belly 3.
- Eccentric exercises are the most common and consistently effective treatment for tendinopathy, including tendinosis of the infraspinatus, subscapularis, and biceps tendons 4.
- Low-level laser therapy and extracorporeal shockwave therapy demonstrate moderate effectiveness, while platelet-rich plasma injections demonstrate inconclusive evidence on their ability to decrease tendinopathy-related pain and improve function 4.
- An intact subscapularis tendon and compensatory teres minor hypertrophy yield lower failure rates for non-operative treatment of irreparable, massive rotator cuff tears, including those involving the infraspinatus and biceps tendons 5.
Clinical Findings and Diagnosis
- Patients with biceps tendinitis or tendinosis usually complain of a deep, throbbing ache in the anterior shoulder, and repetitive overhead motion of the arm initiates or exacerbates the symptoms 2.
- Bicipital groove point tenderness with the arm in 10 degrees of internal rotation is the most common isolated clinical finding in biceps tendinitis 2.
- Ultrasonography is preferred for visualizing the overall tendon, whereas magnetic resonance imaging or computed tomography arthrography is preferred for visualizing the intra-articular tendon and related pathology 2.
Treatment Options
- Conservative management of biceps tendinitis consists of rest, ice, oral analgesics, physical therapy, or corticosteroid injections into the biceps tendon sheath 2.
- Surgery should be considered if conservative measures fail after three months, or if there is severe damage to the biceps tendon 2.
- Minimally invasive procedures are more effective compared to open surgical interventions for treating tendinopathy, including tendinosis of the infraspinatus, subscapularis, and biceps tendons 4.