What is the treatment for biceps tendinitis?

Treatment for Biceps Tendinitis

The treatment for biceps tendinitis should begin with conservative measures including relative rest, ice therapy, NSAIDs, and eccentric strengthening exercises, with surgery reserved only for patients who have failed 3-6 months of conservative therapy. 1, 2

First-Line Conservative Treatment

• Relative Rest: Reduce activities that worsen pain while continuing those that don't exacerbate symptoms to maintain function and prevent muscle atrophy 1, 2
• Cryotherapy: Apply ice through a wet towel for 10-minute periods to provide effective short-term pain relief 1
• NSAIDs: Use for short-term pain relief, though they have no effect on long-term outcomes 1, 3
  • Topical NSAIDs may provide pain relief with fewer systemic side effects compared to oral options 1, 2
  • For acute biceps tendinitis, the recommended starting dose of oral naproxen is 500 mg, followed by 250 mg every 6-8 hours as required 3
• Eccentric Strengthening Exercises: These are effective for tendinopathy treatment and may reverse degenerative changes 1, 2
• Stretching Exercises: Generally helpful and widely accepted for biceps tendinitis 1, 4

Second-Line Interventions

• Corticosteroid Injections: May provide better acute pain relief than oral NSAIDs but do not alter long-term outcomes 1, 5
  • Should be used cautiously as they may inhibit healing and reduce tendon strength when injected into the tendon substance 1, 6
  • Local anesthetic injections into the biceps tendon sheath may be both therapeutic and diagnostic 4
• Orthotics and Braces: Can reinforce, unload, and protect tendons during activity 1, 2
  • Selection should be based on specific needs and patient comfort 2

Advanced Imaging (if needed)

• Ultrasonography: Preferred for visualizing the overall tendon, can show tendon thickening and heterogeneous echogenicity 4, 7
• MRI: Better for visualizing the intra-articular tendon and related pathology, especially if rotator cuff tears or SLAP lesions are suspected 4, 8

Surgical Management

• Surgery: Should only be considered if conservative measures fail after three months, or if there is severe damage to the biceps tendon 1, 4
• Surgical Options: Include biceps tenotomy or tenodesis 6, 8
  • Tenotomy is simpler but may result in cosmetic deformity ("Popeye" muscle)
  • Tenodesis preserves the normal contour of the arm but is technically more demanding 5, 8
  • Choice between procedures depends on patient age, activity level, and cosmetic concerns 7, 8

Common Pitfalls to Avoid

• Misdiagnosis: Biceps tendinitis is often accompanied by rotator cuff tears or SLAP lesions that may require additional treatment 4, 8
• Overreliance on Anti-inflammatories: Many chronic cases represent degenerative tendinosis rather than inflammatory tendinitis 2, 4
• Complete Immobilization: This should be avoided as it leads to muscle atrophy and deconditioning 1, 2
• Premature Return to Activities: Gradual return to activities is essential to prevent recurrence 1, 5