What is the treatment for bicipital tendinitis?

Treatment for Bicipital Tendinitis

The treatment for bicipital tendinitis should consist of relative rest, icing, eccentric strengthening exercises, and NSAIDs for pain relief, with most patients fully recovering within three to six months with conservative management. 1

Initial Conservative Management

Non-Pharmacological Approaches

• Relative rest and activity modification

  • Reduce activities that exacerbate pain
  • Avoid overhead movements that stress the biceps tendon
  • No clear recommendations exist for the duration of rest 1

• Cryotherapy (Ice)

  • Apply melting ice water through a wet towel for 10-minute periods
  • Provides acute relief of tendinopathy pain (Evidence rating: B) 1

• Physical Therapy

  • Eccentric strengthening exercises for the biceps tendon
  • May reverse degenerative changes (Evidence rating: B) 1
  • Deep transverse friction massage to reduce pain

Pharmacological Management

• NSAIDs (First-line)

  • Effective for short-term pain relief but no effect on long-term outcomes (Evidence rating: B) 1
  • Naproxen 500mg initially, followed by 500mg every 12 hours or 250mg every 6-8 hours as required 2
  • Initial total daily dose should not exceed 1250mg, thereafter not exceeding 1000mg daily 2
  • Topical NSAIDs may be effective with fewer systemic side effects 1

• Other Analgesics

  • Can be used if NSAIDs are contraindicated or ineffective
  • No clear evidence that NSAIDs are superior to other analgesics 1

Advanced Interventions

Corticosteroid Injections

• May be more effective than oral NSAIDs for acute pain relief (Evidence rating: B) 1
• Should be used with caution and limited to 2-3 injections with 4-6 weeks between injections 3
• Does not alter long-term outcomes 1
• Local anesthetic injections into the biceps tendon sheath may be both therapeutic and diagnostic 4

Additional Therapies

• Extracorporeal Shock Wave Therapy (ESWT)

  • Safe, noninvasive option for pain relief in chronic tendinopathies (Evidence rating: B) 1
  • Consider before surgical intervention

• Therapeutic Ultrasonography

  • Benefit is uncertain (Evidence rating: B) 1

Surgical Management

• Should be considered if conservative measures fail after three to six months 1, 4
• Options include:
  • Tenodesis (anchoring the tendon to bone)
  • Transfer of the long head of the biceps to the origin of the conjoined tendon
  • Excellent and good results noted in 94% of patients with either procedure 5
  • Arthroscopic-assisted subpectoral biceps tenodesis has shown improvements in function and pain for refractory cases 6

Monitoring and Follow-up

• Pain and function should be reassessed every 4-6 weeks 3
• Adjust treatment plan if no improvement after 8-12 weeks of consistent therapy 3
• Most patients (about 80%) fully recover within three to six months with conservative therapy 1

Special Considerations

• Biceps tendinitis is commonly accompanied by rotator cuff tears or SLAP lesions, which may require separate management 4
• Primary biceps tendinitis (inflammation in the bicipital groove) occurs in only 5% of patients with biceps tendinitis 4
• Diabetic patients may respond less favorably to conservative measures 3
• The most common isolated clinical finding is bicipital groove point tenderness with the arm in 10 degrees of internal rotation 4

By following this treatment algorithm and understanding that most cases resolve with appropriate conservative management within 3-6 months, clinicians can effectively manage bicipital tendinitis while minimizing unnecessary interventions.