Biceps Injuries: A Look at Treatment Trends

Each year, about 10 million people seek medical attention for shoulder injuries, and another 4 million present to physicians with arm injuries. Tendinitis of the long head of the biceps (LHB) is a common inflammatory tenosynovitis, which occurs as the tendon courses along its constrained path within the bicipital groove of the humerus. It typically presents with anterior shoulder pain and is often exacerbated by overuse. In many cases, LHB tendinopathy occurs in combination with other shoulder problems, particularly rotator cuff tendon injuries. “The goal in treating any LHB tendinopathy should be to address the pain in a way that also respects the patient’s lifestyle.” Despite plenty of research into the anatomy of the LHB tendon and conditions that affect it, there is still some controversy on the most appropriate management strategies for patients with these injuries. It’s known that tendinopathy of the LHB has inflammatory, degenerative, overuse-related, and traumatic causes, but the medical literature doesn’t provide evidence to support one specific treatment approach over another; there are advantages and disadvantages to consider for each procedure. In the November 2010 Journal of the American Academy of Orthopaedic Surgeons, my colleagues and I published a review on the diagnosis and treatment of LHB tendinitis to assist physicians who manage these injuries. Determining Treatment Approaches LHB tendinitis is associated with a variety of causes and a wide range of severity. As such, patients must receive a thorough patient history and physical examination, including radiographic imaging, to determine the appropriate diagnosis and treatment for their injury. Once a diagnosis has been established, patients will require non-surgical therapies—rest, ice, NSAIDs, activity modification, and physical therapy—as first-line treatment. Selective...