For patients with tendinopathy both surgical and nonsurgical treatments show promise, need more study

For Immediate Release
11/1/2010 - American Academy of Orthopaedic Surgeons

Synopsis:
A patient with a long head bicep (LHB) tendinopathy, which is a pain and/or tearing of the tendon, may also have a shoulder injury or condition and/or a rotator cuff tear. LHB tendinopahy can be caused by injury, trauma, overuse, inflammation or degeneration. Because of the variety of the causes of this condition, and the range of possible severity, a patient needs a thorough examination, including radiographic imagery to determine the diagnosis and treatment. Traditional treatments include both surgical — biceps tenotomy or tenodesis, between which the article found no preference — and nonsurgical approaches.

"The surgeon's goal in treating any long head biceps tendinopathy is to address the pain in a way that also respects the patient's lifestyle. And, as we found, there is a variety of excellent surgical and nonsurgical options. In developing this review, we also discovered the need for more comparative research data on surgical versus nonsurgical treatment outcomes for this condition," said Shane Nho, MD, an orthopaedic surgeon who practices in Chicago and whose review appears in the November issue of the Journal of the American Academy of Orthopaedic Surgeons.

Statistics:

• Recent studies reported no significant difference in function or patient satisfaction between the two primary surgical options, biceps tenotomy or tenodesis.
• Each year, an average of 10,000 people seeks medical attention from a surgeon or at the ER for a shoulder injury and more than 4,000 people come in with arm injuries.
• Both surgical treatments are statistically successful, with a complication rate of less than 1 percent.

Trends noted:

• Both surgical options now can be performed arthroscopic.
• Review authors seem to agree that of the two surgical options, biceps tenodesis should be used in younger, active patients.
• The first line of treatment for LHB tendinopathy is a variety of non-surgical options, such as:
• Rest;
• anti-inflammatory drugs;
• activity modification; and
• physical therapy.

If those courses do not offer the patient relief, a course of corticosteroid injections may be attempted. The authors do, however, report a concern about intratendinous (within the tendinous portion of the muscle) corticosteroid injections, which may predispose the patient to tendon rupture. This, however, has little documentation to support the concern.

Symptoms:
See your doctor or orthopaedic surgeon if you experience any of these symptoms.

• Sudden, sharp pain in the upper arm
• Sometimes an audible pop or snap
• Cramping of the biceps muscle with strenuous use of the arm
• Bruising from the middle of the upper arm down toward the elbow
• Pain or tenderness at the shoulder and the elbow
• Weakness in the shoulder and the elbow
• Difficulty turning the arm palm up or palm down
• Because a torn tendon can no longer keep the biceps muscle tight, a bulge in the upper arm above the elbow ("Popeye Muscle") may appear, with a dent closer to the shoulder

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More information on tendon, shoulder and bicep injuries can be found at www.orthoinfo.org.

For more information, contact:

Lauren Pearson (847) 384-4031 pearson@aaos.org
Lisa Meyer (847) 384-4033 lmeyer@aaos.org