Treatment trends for biceps injuries

Synopsis: A patient with a long head biceps (LHB) tendinopathy, which is a pain and/or tearing of the tendon, may also have a shoulder problem and/or a rotator cuff tear. LHB tendinopahy can be caused by injury, trauma, overuse, inflammation or degeneration. Because of the variety of the causes and the range of possible severity, a patient needs a thorough examination, including radiographic imaging to determine the diagnosis and treatment. Traditional treatments include both surgical and nonsurgical approaches.

"The surgeon's goal in treating any long head biceps tendinopathy is to address the pain in a way that also respects the patient's lifestyle. And, as we found, there is a variety of excellent surgical and nonsurgical options. In developing this review, we also discovered the need for more comparative research data on surgical versus nonsurgical treatment outcomes for this condition." Said Shane Nho, MD, an orthopaedic surgeon who practices in Chicago and whose review appears in the November issue of the Journal of the American Academy of Orthopaedic Surgeons.

Statistics:

Recent studies reported no significant difference in function or patient satisfaction between the two primary surgical options, biceps tenotomy or tenodesis.
Each year, an average of 10 million people seek medical attention in a surgeon or physician's office or at the ER for a shoulder injury and an average of 4 million people come in with arm injuries.
Both surgical treatments for LHB tendinopathy are statistically successful, with a complication rate of less than 1 percent.
Trends noted:

Both surgical options -- biceps tenotomy and tenodesis (between which the article found no preference) now can be performed via arthroscopy.
The authors agree that nonsurgical treatment is the first - and in many cases may be the only -treatment necessary.
The authors of this review seem to agree that of the two surgical options, biceps tenodesis should be used in younger, active patients.
The first line of treatment for LHB tendinopathy is a variety of nonsurgical options, such as:
Rest;
anti-inflammatory drugs;
activity modification; and
physical therapy.
If those treatments do not offer the patient relief, a course of corticosteroid injections may be attempted. The authors do, however, report a concern about intratendinous (within the tendinous portion of the muscle) corticosteroid injections, which may predispose the patient to tendon rupture. More research is needed to address this concern.

Symptoms:

See your doctor or orthopaedic surgeon if you experience any of these symptoms.

Sudden, sharp pain in the upper arm
Audible popping or snapping in the shoulder or elbow
Cramping of the biceps muscle with strenuous use of the arm
Bruising from the middle of the upper arm down toward the elbow
Pain or tenderness at the shoulder and the elbow
Weakness in the shoulder and the elbow
Difficulty turning the palm of the hand up or down
Because a torn tendon can no longer keep the biceps muscle tight, a bulge in the upper arm above the elbow ("Popeye Muscle") may appear, with a dent (signifying absence of muscle) closer to the shoulder.

Provided by American Academy of Orthopaedic Surgeons