Biceps Tendinopathy Treatment & Management

Updated: Feb 26, 2021
  • Author: Peter G Gonzalez, MD; Chief Editor: Robert H Meier, III, MD  more...
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Rehabilitation Program

Physical Therapy

The components of a physical therapy program, as follows, are coordinated with various stages of the bicipital tendinopathy:

  • Immediate

    • Initiate rest, ice, compression, and elevation (RICE) therapy.

    • Avoid activity that aggravates the condition.

  • Subacute

    • Physical therapy should involve soft-tissue therapy with transverse gliding of the tendon and cross-friction massage.

    • Electrical stimulation and/or ultrasound may be beneficial if symptoms interfere with therapeutic exercise.

    • Apply moist heat to help facilitate stretching and reduce pain.

    • If the shoulder is stable, perform ROM exercises for the shoulder, including gradual stretching of the biceps tendon. Other activities include circumduction, pendulum, 2-hand rod swinging, and lateral/front finger wall walking.

    • Progress to resistive exercises as symptoms subside. Isometrics progress to concentric exercises, then to eccentric exercises, and finally to sport-specific exercises. Eccentric loading in the management of tendinopathies of other muscle groups has shown promise in reversing some degenerative changes. [16]

    • Closed kinetic chain exercises are generally started first, with open kinetic chain exercises initiated later with sport-specific activities.

    • Perform proprioceptive shoulder exercises with a Swiss ball.

    • Address biomechanical factors that may be contributing to the biceps tendinopathy.

  • Long term

    • Continue physical therapy as described.

    • Avoid aggravating factors.

    • Look for other causes or predisposing factors, such as bony abnormalities, labral pathology, and radiculopathy.

A case series by McDevitt et al demonstrated that both dry needling and eccentric concentric exercise may be effective against chronic pain in patients with chronic biceps tendinopathy. [27]

Occupational Therapy

The occupational therapist should instruct the patient with biceps tendinopathy in the use of the appropriate adaptive equipment, in work simplification strategies, in ergonomic modifications, in the stretching of the appropriate shoulder girdle musculature, and in the strengthening program that will eventually be undertaken.


Medical Issues/Complications

Possible complications that can develop from biceps tendinopathy include the following:

  • Recurrent anterior shoulder pain

  • Biceps rupture

  • Weakness

  • Maladaptive compensation strategies by the individual, causing other ailments


Surgical Intervention

Surgery is rarely necessary but may be required in refractory cases associated with persistent pain that has not responded to any other treatment. [9, 10, 11, 12, 13]

Surgery often involves decompression of the musculotendinous structure through tenolysis, using arthroscopic or open surgical technique. [3]


Other Treatment

Injection with anesthetic and corticosteroid into the biceps tendon sheath may be helpful. This can be performed under ultrasonographic guidance to ensure correct placement of the medication. [28] Avoid direct injection into the biceps tendon.

A systemic review and meta-analysis by Aly et al demonstrated that ultrasonographically guided injection showed greater efficacy than landmark-guided injections for the treatment of biceps tendinopathy. [29] Another comprehensive review, by Daniels et al, reported similar results, showing that ultrasonography provided greater efficacy and cost effectiveness in the treatment of biceps tendinopathy. [30]

Myofascial trigger point injections in the scapular stabilizer muscles may be beneficial. This technique uses an injection with dilute local anesthetic.

Manipulation may be helpful, especially for first-rib abnormalities that contribute to the syndrome.

A study by Furia et al indicated that radial extracorporeal shock wave therapy (rESWT) is an effective treatment for chronic distal biceps tendinopathy. The mean visual analog scale scores in patients who underwent rESWT were 8.3 at pretreatment and 2.7 at 12 months posttreatment, compared with 8.3 and 4.7, respectively, in the control group. [31]