Biceps Tendonitis Treatment Options

Biceps tendonitis is an inflammatory condition that affects the tendons that attach the biceps muscle to the bones in the shoulder socket. The biceps muscle is located on the front of the upper arm and controls shoulder and elbow mobility. It has two tendons that attach to the shoulder blade. The long head of the biceps tendon attaches to the top of the shoulder socket. The short head attaches to a bump on the shoulder blade. The long head of the biceps tendon is a shoulder stabilizer and a known pain generator. Biceps tendonitis usually occurs in conjunction with damage to the rotator cuff tendons. What is the treatment for biceps tendonitis?

Nonoperative Management

Initial treatment for biceps tendonitis is nonsurgical and involves rest, icing, activity modification, Anti-inflammatory medications and most importnatly, physical therapy. If the pain remains, corticosteroid injections can be considered, which act to reduce the inflammation and allow the tendon to heal.

Biceps Tenodesis

While nonoperative treatments are always the first line of treatment for biceps tendonitis, if the symptoms persist despite these interventions, biceps tenodesis can be considered. It is particularly suitable for individuals with chronic biceps tendonitis or cases where the tendon is severely degenerated. Importantly, tenodesis is often combined with other necessary surgical procedures, such as rotator cuff tear repairs.

Biceps tenodesis is performed under general anesthesia. During the minimally invasive procedure, Dr. Kaplan will make a small incision and insert an arthroscope into the shoulder to view inside the joint and confirm the diagnosis of a torn or damaged biceps tendon as well as evaluate other shoulder damage including the rotator cuff. The tendon is trimmed, detached from its original location and reattached to the upper arm bone with anchor devices.

Recovery will include wearing a sling initially, participating in physical therapy, and gradually resuming normal activities. Full recovery can take 4-6 months.

Biceps Tenotomy

This procedure involves the intentional cutting or severance of the long head of the biceps tendon, without reattaching it. It is typically considered when the biceps tendon is significantly damaged or degenerated, often due to chronic inflammation, and partial tears, the condition is not reparable, and conservative treatments have failed to alleviate symptoms. Tenotomy is a pain-relieving procedure.

However, the procedure can lead to a change in the contour of the biceps muscle, sometimes referred to as a “Popeye” bulge, where the muscle balls up slightly due to the retraction of the tendon. This is a cosmetic issue and does not usually affect the functional capacity of the arm.

Choosing between a tenotomy and tenodesis usually depends on factors such as the patient’s age, activity level, and cosmetic concerns, all of which will be discussed with Dr. Kaplan to help determine the best approach based on your individual needs and expectations.

Post-operative physical therapy is essential to stabilize the shoulder, restore strength and improve range of motion.

Schedule a shoulder consultation

When you or a loved one has severe shoulder pain, contact Dr. Daniel J. Kaplan at NYU Langone Brooklyn office to schedule a consultation. He is a shoulder expert and can diagnose your problem and offer the best treatment options for your condition. Dr. Daniel Kaplan is a fellowship-trained orthopedic surgeon who specializes in sports medicine and shoulder surgery. He is also the chief of sports medicine at Bellevue Hospital and the chief of sports medicine at the VA hospital in Manhattan. His expertise is in minimally invasive arthroscopic and advanced open reconstruction procedures to treat biceps tendonitis.