From the Guidelines
The treatment for long head of biceps tendon rupture is primarily conservative management for most patients, especially older and less active individuals. Initial treatment includes rest, ice, compression, and elevation (RICE protocol) for 1-2 weeks, along with NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for pain and inflammation, as supported by the latest guidelines and studies 1.
Key Considerations
- Physical therapy should begin after acute pain subsides, focusing on progressive strengthening exercises and range of motion restoration over 6-12 weeks.
- Surgical repair is generally reserved for young, active patients or athletes with high functional demands, and should ideally be performed within 2-3 weeks of injury for optimal outcomes, as noted in recent research 1.
- The decision between conservative and surgical management depends on the patient's age, activity level, occupation, and cosmetic concerns.
- Most patients regain nearly full function with conservative treatment despite the characteristic "Popeye deformity" (distal muscle bulge), with the remaining short head of the biceps preserving approximately 80% of supination strength and 60% of elbow flexion strength.
Diagnostic Imaging
- MRI is particularly useful in the assessment of biceps tears, with improved sensitivity for the detection of partial tears of the biceps and triceps tendons, as demonstrated in a study of 77 patients 1.
- The use of noncontrast MRI in the assessment for ligamentous and tendinous injury has shown good interobserver agreement, especially for lateral collateral complex injuries 1.
Treatment Outcomes
- The good functional prognosis with non-operative management is due to the remaining short head of the biceps, which preserves a significant portion of supination and elbow flexion strength, allowing most patients to regain nearly full function with conservative treatment 1.
- Recent studies have highlighted the importance of individualized treatment approaches, taking into account the patient's specific needs and circumstances, to optimize outcomes for long head of biceps tendon rupture 1.
From the Research
Treatment Protocol for Long Head of Biceps Rupture
- The treatment protocol for long head of biceps rupture typically involves nonsurgical management as the first line of treatment, including rest and activity modification, use of nonsteroidal anti-inflammatory drugs, physical therapy, and corticosteroid injections 2.
- Patients with symptoms that are refractory to nonsurgical management are indicated for biceps tenotomy or various tenodesis procedures 2.
- Studies have shown that both tenotomy and tenodesis have been effective options in the management of long head of the biceps tendinopathy, with advantages to each procedure 2, 3.
- Surgical treatment can be recommended for younger individuals, manual workers, and sportsmen, and rarely for cosmetic reasons, or when a subacromial impingement due to a disturbing proximal tendon stump is present 3.
- Conservative treatment has been shown to have similar outcomes to surgical treatment for pain and range of motion, but may have poorer outcomes in terms of strength after treatment 4.
- Physical therapy interventions, including exercise, manual therapy, and patient education, have been recommended for the management of long head of the biceps tendinopathy 5.
Comparison of Treatment Options
- A systematic review found that conservative treatment had some poorer outcomes in terms of strength after treatment, while surgical treatment had more complications and a few patients with decreased satisfaction 4.
- Another study found that patients who underwent surgery lost, on average, only 8% strength for elbow flexion and 7% for forearm supination, compared to 16% and 11% respectively for patients who underwent conservative treatment 3.
- The choice of treatment option should be based on a shared decision-making process that incorporates patient priorities and takes into account the pros and cons of both options 4.