Oral Steroids for Chronic Bicep Tendinopathy
Oral steroids are not recommended for chronic bicep tendinopathy as they may inhibit healing, reduce tendon tensile strength, and predispose to tendon rupture, while providing only short-term relief without improving long-term outcomes. 1
Evidence Against Oral Steroids for Tendinopathy
- Corticosteroids may inhibit healing and reduce the tensile strength of tendon tissue, potentially predisposing to spontaneous rupture 1
- There are no evidence-based guidelines supporting the use of corticosteroids in tendinopathy, and there may be deleterious effects when used for tendon disorders 1
- While corticosteroid injections may provide short-term relief, they do not alter long-term outcomes of pain in tendinopathy 1, 2
- Studies show that corticosteroid effects are reversed at intermediate and long terms, with non-intervention actually being favored over corticosteroids in these timeframes 2, 3
Recommended Treatment Approach for Bicep Tendinopathy
First-Line Treatments
- NSAIDs (oral or topical) for short-term pain relief with fewer systemic side effects when used topically 1, 4, 5
- Rest and activity modification to avoid movements requiring repetitive wrist flexion and extension 1, 6
- Ice therapy for 10-minute periods through a wet towel for short-term pain relief 1
- Consider bracing or orthotics to unload the tendon 1
Second-Line Treatments
- Physical therapy with emphasis on eccentric strengthening exercises that can help reverse degenerative changes 4, 5
- If conservative treatment fails after 6 weeks, consider referral for surgical evaluation 1, 5
Potential Risks of Oral Steroids
- Gastrointestinal complications including bleeding, ulceration, and perforation 1
- Increased risk of serious adverse events with prolonged use 1, 4
- Potential for tendon weakening and increased risk of rupture 1, 3
- Negative effects on bone density with long-term use 7
Common Pitfalls to Avoid
- Premature return to aggravating activities before adequate healing 1
- Relying on corticosteroids (oral or injected) for long-term management 1, 2
- Using multiple corticosteroid injections, which may lead to tissue weakening 1
- Overlooking the importance of relative rest and activity modification in the treatment plan 1, 5
Alternative Treatments with Better Evidence
- Sodium hyaluronate injections have shown better results than placebo for pain reduction in both short and long term for similar tendinopathies 2, 3
- Surgical management (tenotomy or tenodesis) may be indicated for refractory or severe disease 6, 5
In conclusion, while oral steroids might temporarily reduce pain in bicep tendinopathy, the potential risks outweigh the benefits, particularly given their lack of long-term efficacy and potential to cause tendon weakening and rupture. A more conservative approach using NSAIDs, rest, ice, and physical therapy should be attempted first, with surgical options considered for refractory cases.