Overview
Biceps tendinitis involves inflammation or degeneration of the long head of the biceps (LHB) tendon, often causing anterior shoulder pain and functional impairment. Surgical interventions like tenodesis are increasingly utilized for persistent symptoms, particularly in younger patients 1.Diagnosis
Clinical Presentation: Anterior shoulder pain exacerbated by activities involving the arm 15.
Imaging: Ultrasonography can identify tendovaginitis and degenerative changes in the biceps tendon 5.
Radiographic Assessment: X-rays may reveal variations in the bicipital groove anatomy, correlating with tendon disease in some cases 5.Management
First-Line Treatments: Conservative management including rest, physical therapy, and anti-inflammatory medications 15.
Surgical Interventions:
- Subpectoral Tenodesis: Techniques include in situ tenodesis with residual stump vs. tenotomy followed by resection 1.
- Botulinum Toxin A (BTX-A): For post-tenotomy bicipital cramping, intramuscular injection (100 IU) shows significant pain reduction and functional improvement 2.Special Populations
Young Patients: Subpectoral tenodesis techniques aim to restore length-tension relationship effectively 1.
Chronic Cases: Reconstruction using grafts (e.g., semitendinosus autograft, Achilles tendon allograft) may be necessary for distal biceps ruptures beyond 18 months 4.Key Recommendations
Consider Subpectoral Tenodesis Techniques for young patients with biceps tendinitis to optimize functional and cosmetic outcomes (Evidence: Moderate 1).
Utilize Botulinum Toxin A Injections for persistent painful cramping post-biceps tenotomy to achieve significant pain relief and functional improvement (Evidence: Moderate 2).
Evaluate Bicipital Groove Anatomy radiographically in patients with chronic biceps tendinopathy to identify anatomical factors contributing to symptoms (Evidence: Weak 5).References
1 Trefzer R, Diermayr S, Etter M, de Jong M, Wehrli M, Audigé L et al.. Subpectoral biceps tenodesis with BicepsButton fixation in the young population: which technique works best?. Journal of shoulder and elbow surgery 2023. link
2 Torrekens M, Vanmierlo B, Van Isacker T. The effectiveness of a Botulinum Toxin A infiltration in the management of bicipital cramps after arthroscopic biceps tenotomy. Acta orthopaedica Belgica 2021. link
3 Werner BC, Brockmeier SF, Gwathmey FW. Trends in long head biceps tenodesis. The American journal of sports medicine 2015. link
4 McCarty LP, Alpert JM, Bush-Joseph C. Reconstruction of a chronic distal biceps tendon rupture 4 years after initial injury. American journal of orthopedics (Belle Mead, N.J.) 2008. link
5 Pfahler M, Branner S, Refior HJ. The role of the bicipital groove in tendopathy of the long biceps tendon. Journal of shoulder and elbow surgery 1999. link90070-8)