Biceps tendon tear treatment

Ross Hauser, MD., Danielle R. Steilen-Matias, MMS, PA-C

As with many of the conditions we treat at Caring Medical, a biceps tendon tear or a chronic condition of biceps tendinopathy is not a problem that we see as an isolated problem. The problem of the biceps tendon in the shoulder is usually one problem existing among many shoulder problems.

Here are the typical stories we hear at our center when someone with shoulder problems contacts us:

Rotator cuff, damage to the biceps tendon, and the shoulder labrum

Supraspinatus and biceps tendon

More MRIs come in than stories

Bicep tendon problems are one of the problems that we see that when people contact us, they will send us a cut and paste of their MRI impression and ask, “can you fix this.” Unfortunately, many of these people do not tell us about their shoulder pain, their daily quality of life, or their limitations. Just an MRI report and “can you fix this.” Our treatments are based on physical examination and the functional capabilities of the shoulder. An MRI can be helpful but it may not be the “tell-all,” that some people think an MRI is. Usually, when they send in a cut and paste MRI report it is because they were told to have surgery. As we will see below, sometimes, in cases of complete tear or rupture, surgery may be the only answer. In cases of partial tears, surgery, for many people, can be avoided.

“Tendinopathy of the long head of the biceps tendon is a difficult medical issue.”

Here is a recent research examination (1) of the problems in understanding biceps tendinopathy. It comes from a team of pathologists whose job it is to understand, as best they can, biceps tendinopathy. Here are the learning points and our interpretation.

“Tendinopathy of the long head of the biceps tendon is a difficult medical issue. Its pathogenesis and etiology are multifactorial and unclear. Tendinopathy is thought to be primarily degenerative in nature, as tendons are characterized by impaired regeneration and healing.”

Simply, it is a wear and tear disease that inflammation gives up on. What does this mean? The body thinks the tendon cannot heal. 

Simply, it is a wear and tear disease and at some point tendinitis, that is inflammation and the natural healing response shuts down because either the tendon is healed, or the body thinks the tendon cannot heal. So tendinitis turns into tendinosis. Pain without inflammation. It is at this point that anti-inflammatories and cortisone become ineffective.

What this study points out is that non-healing biceps tendinopathy is not a problem of too much inflammation, but rather not enough inflammation. How can this be? Let’s let the pathologists describe this.

Bicep tendon degeneration usually is not a limited or isolated problem. It is one condition among many in a problem shoulder.

In the above study, the pathologists noted what we see clinically and empirically. That bicep tendon degeneration usually is not a limited or isolated problem. It is one condition among many in a problem shoulder.

The research above was conducted among 35 patients who had a shoulder arthroscopy: This was their general description:

What are we seeing in this image?

In the image below we note that the Biceps pulley is a complex shoulder ligament complex that keeps the long head of the biceps tendon in the bicipital groove (the notch of the humerus bone.)

As noted in a paper published in the journal Radiographics. (2)

biceps pulley

Biceps Tendon Tear Treatment

Prolotherapy specialist Danielle Matias, MMS, PA-C discusses biceps tendon tears and when we would see a patient with a biceps tendon injury in our office for Comprehensive Prolotherapy injections vs. when it is a surgical case. She also explains how ultrasound is used during the Prolotherapy series to look for objective improvement of tissue integrity.

 

While the biceps tendon originates at the shoulder and goes down to attach at the elbow. In this video, we will focus on injuries at the shoulder.

It is a surgical problem when:

Non-surgical options can help when:

What are we seeing in this image?

The pools of black and dark grey fluid permeating throughout the tendon revealed on ultrasound.

Picture of bicep tendinosis

Before and after Prolotherapy treatment

What are we seeing in this image?

Biceps Tendon Ultrasound

This patient also had ligament laxity in his shoulder and some rotator cuff degeneration. This is why we treat the whole shoulder. As mentioned above, bicep tenons problems are usually not isolated injury.

In this video, a general demonstration of Prolotherapy and PRP treatment is given.

Danielle R. Steilen-Matias, MMS, PA-C narrates the video and is the practitioner giving the treatment:

Questions about our treatments?

If you have questions about Biceps tendon tear treatment and how we may be able to help you, please contact us and get help and information from our Caring Medical staff.

This is a picture of Ross Hauser, MD, Danielle Steilen-Matias, PA-C, Brian Hutcheson, DC. They treat people with non-surgical regenerative medicine injections.

Brian Hutcheson, DC | Ross Hauser, MD | Danielle Steilen-Matias, PA-C

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References

1 ZabrZyński J, Paczesny Ł, ŁaPaJ Ł, Grzanka D, Szukalski J. Is the inflammation process absolutely absent in tendinopathy of the long head of the biceps tendon? Histopathologic study of the long head of the biceps tendon after arthroscopic treatment. Polish Journal of Pathology. 2017 Jan 1;68(4):318-25. [Google Scholar]
2 Nakata W, Katou S, Fujita A, Nakata M, Lefor AT, Sugimoto H. Biceps pulley: normal anatomy and associated lesions at MR arthrography. Radiographics. 2011 May;31(3):791-810. [Google Scholar]

 

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