Biceps Tendinopathy

Bicep tendinopathy is an overload/overuse condition of the long head of the biceps tendon which originates from the cartilage structure on the shoulder socket (labrum) and is positioned within a groove in the upper arm bone (humerus) known as the bicipital groove. Sudden bicep tendinopathy may occur because of overuse due to a sudden increase in activity, especially among athletic patients aged 18- 35, and any patient aged over 65. It can accompany other shoulder related pathologies.

• Relative sudden overload or increase in activity, particularly overhead ⁽¹⁾.
• Rotator cuff tears, particularly those that involve the subscapularis tendon ⁽³⁾.
• Persistent rotator cuff tears (>3 months) ⁽⁵⁾.

The exact incidence of biceps tendinopathy is unknown, however usually we see degenerative (wear and tear) or reactive (overload) tendinopathy of the bicep which commonly affect slightly different age groups.

• Degenerative tendinopathy – most common in people over the age of 65 as part of the normal ageing process and can be improved with physiotherapy and strength-based rehabilitation.
• Reactive tendinopathy – most common in overhead and throwing athletes aged 18-35 and is usually seen in conjunction with an increase in training or play, or a return to sport following an absence.

Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.

Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and allow appropriate adjustments to your treatment to be made. Imaging studies like MRI or ultrasound scans are usually not required to achieve a working diagnosis, but in unusual presentations, they may be warranted.

Initially reducing pain, reducing the load on the tissue through activity modification and avoiding aggravating activities where possible. Your physiotherapist will guide you on how to reduce load safely and effectively whilst maintaining activity.

For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.

As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from further assessment to ensure you are making progress and to establish appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.

• Surgery may be considered in traumatic cases, or if conservative management has shown no improvement after 3 months ⁽⁶⁾.
• Non-steroidal anti-inflammatory drugs (NSAIDs) can be helpful for management of pain.
• Steroid injections can be considered secondary to active rehabilitation.

https://www.shoulderdoc.co.uk/article/722