From the Guidelines
Treatment for a distal biceps tendon partial tear should begin with conservative management, including rest, ice, compression, and elevation (RICE protocol) for 1-2 weeks, along with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) to reduce pain and inflammation. This approach is supported by the American Family Physician journal, which recommends relative rest to decrease repetitive loading of the damaged tendon 1.
The conservative management approach typically includes:
- Rest, ice, compression, and elevation (RICE protocol) for 1-2 weeks
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily)
- Physical therapy initiated after the acute phase, focusing on gentle range of motion exercises followed by progressive strengthening of the biceps muscle over 6-12 weeks
- A hinged elbow brace may be recommended to protect the tendon while allowing controlled movement
Most partial tears respond well to conservative treatment, with full recovery taking 3-6 months depending on tear severity 1. Surgery is generally reserved for cases that fail to improve after 3 months of conservative treatment, complete tears, or for patients with high functional demands 1. The conservative approach works because partial tears maintain some structural integrity and the biceps has good healing capacity when properly protected and gradually rehabilitated.
It's essential to note that rest prevents ongoing damage, reduces pain, and may promote tendon healing, while tensile loading of the tendon stimulates collagen production and guides normal alignment of newly formed collagen fibers 1. Eccentric exercise has proved beneficial in Achilles tendinosus and patellar tendinosus and may be helpful in other tendinopathies. Stretching exercises are also thought to be helpful and are widely accepted.
In terms of imaging studies, MRI is sensitive and specific for the detection of cuff tears, degeneration, chronic tendinopathy, and partial tears, and can be useful in diagnosing distal biceps tendon partial tears 1. However, the treatment approach should prioritize conservative management, with surgery considered only when conservative treatment fails or in cases with high functional demands.
From the Research
Treatment Options for Distal Biceps Tendon Partial Tear
The treatment for a distal biceps tendon partial tear can be either conservative or surgical, depending on the severity of the tear and the patient's needs.
- Conservative management is often recommended for partial tears that involve less than 50% of the tendon 2.
- Surgical intervention is usually considered for tears that involve more than 50% of the tendon, as these are more likely to fail conservative management 2, 3.
Conservative Management
Conservative treatment typically includes immobilization, medication, and physical therapy.
- This approach can be successful in managing partial tears, especially those that are less severe 4.
- However, conservative treatment may result in poorer outcomes in terms of strength after treatment compared to surgical treatment 5.
Surgical Intervention
Surgical treatment involves repairing the torn tendon, and it can be performed using an open or endoscopic approach.
- Surgical repair can provide superior outcomes in terms of strength, endurance, and patient-reported outcomes compared to conservative management 5, 6.
- However, surgical treatment is associated with a higher complication rate and may not always result in higher patient satisfaction 5.
Decision-Making
The decision between conservative and surgical treatment should be made on a case-by-case basis, taking into account the patient's objectives, needs, and the severity of the tear.
- A high index of suspicion is necessary to diagnose partial distal biceps tendon tears, and magnetic resonance imaging (MRI) can be useful in confirming the diagnosis 2, 4.
- The treatment algorithm should be individualized, and patients should be involved in the decision-making process to ensure that their needs and expectations are met 2, 5.