Overview
Tendinitis of the left biceps brachii involves inflammation or irritation of the biceps tendon, typically causing pain, weakness, and functional impairment, particularly during elbow flexion and forearm supination 1.Diagnosis
Clinical presentation includes pain localized to the anterior aspect of the elbow and weakness in supination and flexion 1.
Imaging studies (MRI, ultrasound) may help confirm diagnosis by identifying tendon thickening, partial tears, or inflammation 1.
Functional assessments such as the Constant score and ASES (American Shoulder and Elbow Surgeons) score can quantify functional impairment and pain levels 1.Management
First-line treatments: Conservative management including rest, activity modification, nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation 1.
Physical therapy: Focus on strengthening exercises for the shoulder and elbow, particularly those targeting rotator cuff and scapular stabilizers 1.
Injection therapy: Corticosteroid injections may provide short-term relief from pain and inflammation 1.
Surgical interventions:
- Tenodesis is recommended over tenotomy for better functional outcomes and reduced bicipital cramping pain 1.
- Consider surgical options if conservative measures fail after several weeks to months 1.Special Populations
Elderly: Conservative management is often preferred due to higher surgical risks; however, individualized assessment is crucial 1.
Comorbidities: Patients with significant comorbidities may benefit more from conservative treatments initially, with surgical options reserved for severe refractory cases 1.Key Recommendations
Prefer tenodesis over tenotomy for surgical intervention in biceps tendon pathology to achieve better functional results and less bicipital cramping pain (Evidence: Strong 1).
Initiate treatment with conservative measures including NSAIDs, physical therapy, and activity modification before considering surgical options (Evidence: Moderate 1).
Evaluate surgical candidates carefully, considering individual patient factors such as age and comorbidities, to tailor the approach appropriately (Evidence: Expert opinion 1).References
1 Vajda M, Szakó L, Hegyi P, Erőss B, Görbe A, Molnár Z et al.. Tenodesis yields better functional results than tenotomy in long head of the biceps tendon operations-a systematic review and meta-analysis. International orthopaedics 2022. link