Treatment for Bicipital Tendinitis
The treatment for bicipital tendinitis should follow a stepwise approach, beginning with conservative management including rest, ice, oral analgesics, physical therapy, and potentially corticosteroid injections, with surgery considered only if conservative measures fail after three months. 1
Conservative Management (First-Line)
Activity Modification and Rest
- Reduce activities that exacerbate shoulder pain
- Avoid overhead movements that stress the biceps tendon
- Relative rest rather than complete immobilization
Physical Therapy
- Eccentric strengthening exercises for the rotator cuff
- Deep transverse friction massage to reduce pain
- Stretching exercises to maintain range of motion
Medications
- NSAIDs as first-line medication for pain and inflammation
- Acetaminophen as an alternative if NSAIDs are contraindicated
- For severe cases:
- Gabapentin for neuropathic pain components
- Methocarbamol for acute muscle spasms (limited to short-term use of 7 days)
Local Interventions
- Corticosteroid injections into the biceps tendon sheath
- Limited to 2-3 injections
- 4-6 weeks between injections
- Both therapeutic and diagnostic value 1
- Ice application to reduce inflammation
Advanced Interventions
- Extracorporeal Shock Wave Therapy (ESWT) for chronic cases before considering surgery
Surgical Management
Surgery should be considered in the following circumstances:
- Failure of conservative treatment after 3 months 1
- Severe damage to the biceps tendon
Surgical Options
- Biceps tenodesis (fixing the tendon to the humerus)
- Has shown excellent and good results in 94% of patients 2
- Transfer of the long head of biceps to the origin of the conjoined tendon
- Arthroscopic removal of pathology if associated with other shoulder conditions
Monitoring and Follow-up
- Reassess pain and function every 4-6 weeks
- Adjust treatment plan if no improvement after 8-12 weeks
- Imaging (ultrasound or MRI) may be used to evaluate tendon integrity
Special Considerations
Associated Conditions
- Biceps tendinitis is commonly accompanied by rotator cuff tears or SLAP lesions 1
- Evaluate for these conditions, especially if symptoms persist
Anatomical Variations
- Anomalous origins of the long head biceps tendon may predispose to chronic biceps tendinitis resistant to conservative care 3
- In young patients with refractory symptoms, consider anatomical variations
Uncommon Causes
- Rare causes such as osteochondromas 4 or humeral head osteonecrosis 5 should be considered in cases not responding to standard treatment
Prognosis
- Most cases respond well to conservative management
- Even with optimal management, resolution typically requires 3-6 months
- Post-surgical recovery period is also typically 3-6 months