What is the management of a biceps tendon tear (biceps tendinopathy)?

From the Guidelines

The management of a biceps tendon tear (biceps tendinopathy) should prioritize conservative treatment, including relative rest, ice application, compression, and elevation, as well as pain management with NSAIDs, before considering surgical intervention, as recommended by studies such as 1. When considering the treatment of biceps tendinopathy, it is essential to take into account the location and severity of the injury.

• For partial tears or complete tears in less active individuals, conservative treatment is often recommended, including:
  • Relative rest to decrease repetitive loading of the damaged tendon, as suggested by 1
  • Ice application for 20 minutes every 2-3 hours during the first 48 hours
  • Compression with an elastic bandage
  • Elevation of the affected arm
• Pain management typically involves NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks.
• Physical therapy should begin after the acute phase, focusing on gentle range of motion exercises progressing to strengthening exercises over 6-12 weeks. However, surgical repair within 2-3 weeks of injury may be warranted for complete tears in active individuals or athletes, especially distal biceps tears, as it provides better functional outcomes, and is supported by studies such as 1. It is crucial to weigh the potential benefits of surgical intervention against the risks, considering the potential 30-40% loss of supination strength and 20% loss of flexion strength that can occur with untreated complete distal biceps tears, particularly important for individuals requiring arm strength for work or sports activities. In the case of surgical intervention, recovery requires immobilization for 1-2 weeks followed by progressive rehabilitation for 3-6 months. Proximal biceps tears are less commonly repaired surgically unless they cause significant symptoms. Ultimately, the decision to proceed with surgical intervention should be made on a case-by-case basis, taking into account the individual's overall health, activity level, and treatment goals, as well as the potential risks and benefits of surgery, as discussed in studies such as 1 and 1.

From the Research

Management of Biceps Tendon Tear

The management of a biceps tendon tear, also known as biceps tendinopathy, can be approached through various methods, including conservative treatment and surgical intervention.

• Conservative treatment may include therapeutic exercise, manual therapy, and cryotherapy, as outlined in a case report of a 23-year-old male patient with a full-thickness tear of the biceps brachii muscle 2.
• Surgical management, on the other hand, has demonstrated adequate outcomes in short and mid-term studies, with long-term outcomes showing robust clinical success 3.
• Nonsurgical treatment options, such as anti-inflammatory medications, physical therapy, and ultrasound-guided corticosteroid injections, should be utilized before entertaining surgical treatment options 4.
• If surgery is needed, options include biceps tenotomy, biceps tenodesis, or superior labrum anterior to posterior repair, with recent studies analyzing open vs arthroscopic techniques and the ideal location of tenodesis 4.

Comparison of Treatment Options

Comparative evidence on treating biceps tendon tears is limited, but a meta-analysis on rotator cuff tears found that surgery is not more effective than conservative treatment alone, with a conservative approach advocated as the initial treatment modality 5.

• However, the use of long head of biceps tendon autograft in the management of large to massive rotator cuff tears has shown promising results, with improved functional, clinical, and radiological outcomes 6.
• The choice of treatment ultimately depends on the individual patient's condition, medical history, and preferences, with orthopaedic surgeons playing a crucial role in counseling patients and determining the best course of treatment 4.

Treatment Outcomes

Treatment outcomes for biceps tendon tears can vary depending on the method of treatment and individual patient factors.

• Conservative treatment has been shown to result in significant improvements in pain and function, with a case report demonstrating a 6-month follow-up with no functional limitations or pain 2.
• Surgical management has also demonstrated high rates of success, with a study showing that patients maintained near-normal range of motion and excellent elbow flexion strength at long-term follow-up 3.
• The use of long head of biceps tendon autograft has also shown improved functional scoring and range of motion, with reduced re-tear rates compared to standard arthroscopic repair 6.