Management Of Biceps Tendon Pain At The Elbow

Management Of Biceps Tendon Pain At The Elbow

Diagnosis Of Biceps Tendon Pain At The Elbow

Generally when dealing with biceps tendon pain the diagnosis made is a clinical one and can be “landed on” following performing a thorough history and physical examination of the area. A clinical diagnosis refers to a diagnosis that your physiotherapist (or other medical practitioner) is able to make without any need of medial imaging. However when a diagnosis is in doubt, or assessing the severity of tissue change is considered relevant (as may be the case in particularity stubborn conditions) or if the biceps tendon pain is causing significant functional limitations, the use of ultrasound imaging, or MRI can be beneficial. Although plain X-rays of the elbow are generally not of much use in confirming a diagnosis of biceps tendinopathy, X-rays can be of great use when looking to rule other other conditions; such as osteoarthritis of the elbow joint, a condition that can cause both pain at the elbow and bone spurs that potentially may increase the exposure of the biceps tendon to mechanical impingement, compression. X-rays can also help pick up the presence of calcification in a tendon, and given that calcification, impingement conditions and osteoarthritis of the elbow would all require a somewhat different treatment approach to classical non-compression related biceps tendinopathy, this highlights why although an X-ray mainly picks up bone and joint changes, sometimes when diagnosis is unclear even an X-ray can provide some great information when managing a distal biceps tendinopathy.

Biceps Tendon Pain Prognosis

The majority of patients with biceps tendon pain at the elbow given time will heal and conservative treatment such as physiotherapy can help accelerate the process and reduce recurrence risk. Often with biceps tendon pain individuals will return to full function and be pain-free within weeks after the original onset of pain, or limitation. Occasionally recovery can take longer than this and similar to other stubborn tendon complaints a return to full function may take months. Early assessment and treatment of biceps tendon pain can play a vital role in accelerating recovery and aiding the return to full function within weeks rather than the suffering the dreaded months of pain and disability.

Biceps Tendon Pain Treatment

The majority of individuals suffering biceps tendon pain at the elbow first line of treatment is simply rest, rest and modification of activities that cause aggravation frequently makes up the lions share of helping settle symptoms in the initial stages. Rest is crucial, rest allows the body to begin the healing process, avoiding any further stress, or damage to the tissue. Ultimately, success of any treatment is generally dictated by patient compliance, their compliance to rest, the avoidance of aggravating activities and adherence to any physiotherapy guided treatment approaches and self guided loading exercises. Your physiotherapist will most likely guide you through a graduated strengthening, loading program for the biceps which may include elbow flexion loading and supination loading depending on the functional limitations and demands. Eccentric loading exercises have a well documented history for use in the rehabilitation of of other tendon complaints, including Achilles and patella tendinopathies. Tendon conditioning approaches like the use of eccentric and isometric loading exercises are successfully used in the management of many tendinopathies, including distal biceps tendinosis. Ignoring symptoms, pushing through and adopting a ‘no pain, no gain’ attitude may increase the likelihood of developing chronic elbow tendon pain. In chronic situations healing stalls, or significantly slows, increasing recovery times, frustration and likelihood of future recurrence. The major frustration should be that this is generally an avoidable situation, typically there is no need for biceps tendon pain to become chronic as it can successfully be treated with physiotherapy and other medical approaches.

Other Treatment Options For Biceps Tendinopathy

If standard conservative treatment options like rest and/or physiotherapy don’t resolve the complaint, then other approaches may be considered, including, the use of:
  • Pharmaceutical intervention – prescribed medications oral tablets, or topical creams and patches
  • Shockwave therapy (radial extracorporeal shock wave therapy (rESWT)). Shockwave therapy is a very effective treatment approach when looking to manage many of the bodies tendinopathies.
  • Platelet rich plasma therapy (PRP), harnessing the use of your own bodies growth factors to enhance healing.
  • Corticosteroid into the biceps tendon sheath to address chronic or acute inflammation with a powerful anti-inflammatory.
If all this fails to satisfactorily alleviate symptoms, then in some cases surgical assessment and arthroscopic treatment of the attachment of the biceps tendon to the bone may help to identify/manage any tearing, or compression of the tendon. Disclaimer: Sydney Physio Clinic provides this information as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on Management Of Biceps Tendon Pain At The Elbow should consult his or her general practitioner, sports medicine specialist, orthopedic surgeon, physiotherapist or otherwise appropriately skilled practitioner.