From the Guidelines
Treatment for biceps tenosynovitis should begin with relative rest and reduced activity to prevent further damage and promote healing and pain relief. This approach is supported by evidence from a 2005 review of common overuse tendon problems, which recommends relative rest and reduced activity as a key component of treatment 1.
Key Components of Treatment
- Relative rest and reduced activity to prevent further damage and promote healing and pain relief
- Cryotherapy, such as repeated applications of melting ice water through a wet towel for 10-minute periods, for acute relief of tendinopathy pain 1
- Eccentric strengthening as an effective treatment of tendinopathy, which may reverse degenerative changes 1
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for short-term pain relief, although they have no effect on long-term outcomes 1
Additional Treatment Options
- Topical NSAIDs may be effective and have fewer systemic side effects, although it is unclear whether they are better than other analgesics 1
- Locally injected corticosteroids may be more effective than oral NSAIDs in acute-phase pain relief, but do not alter long-term outcomes 1
- Surgery is an effective option in carefully selected patients who have failed three to six months of conservative therapy 1
Important Considerations
- The duration of rest and avoidance of activity is not clearly defined, and treatment should be individualized based on patient response and clinical judgment
- Orthotics and braces may be used based on clinical experience and patient preference, although there is no conclusive evidence to support their use 1
- Therapeutic ultrasonography, corticosteroid iontophoresis, and phonophoresis are of uncertain benefit for tendinopathy, and extracorporeal shock wave therapy may be a safe and effective but expensive means of pain relief 1
From the Research
Treatment Options for Biceps Tenosynovitis
- Conservative management of biceps tenosynovitis consists of rest, ice, oral analgesics, physical therapy, or corticosteroid injections into the biceps tendon sheath 2
- Local anesthetic injections into the biceps tendon sheath may be therapeutic and diagnostic 2
- Surgery should be considered if conservative measures fail after three months, or if there is severe damage to the biceps tendon 2
- Compound betamethasone injection combined with musculoskeletal ultrasonography can be an effective treatment for tenosynovitis of the long head of the biceps brachii tendon, with benefits including reduced pain and improved joint function 3
Corticosteroid Injections
- Corticosteroid injection is the mainstay treatment for stenosing tenosynovitis 4, 5
- The effectiveness of corticosteroid injections can depend on the dosage and volume used, with studies suggesting that lower doses (e.g. 10mg of triamcinolone) can be as effective as higher doses (e.g. 20mg of triamcinolone) in resolving symptoms 5
- Multiple injections may be necessary to achieve complete symptom resolution, with some studies suggesting that second and third injections can increase the overall remission rate without increasing morbidity 4
Alternative Therapies
- Radial shock wave therapy (RSWT) is an alternative treatment option for tenosynovitis, although studies suggest that compound betamethasone injection combined with musculoskeletal ultrasonography may be more effective 3
- Physical modalities such as ultrasound therapy, low level laser therapy, and extracorporeal shock wave therapy (ESWT) may be effective in treating tenosynovitis, although more high-quality studies are needed to define evidence-based practice 6