General Guideline Principles for Biceps Tendinosis (or Tendinitis)
and Tears/Ruptures for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Biceps Tendinosis (or Tendinitis) and Tears/Ruptures.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Biceps Tendinosis (or Tendinitis) and Tears/Ruptures

A real muscular strain, biceps tendinosis (or tendinitis) affects the muscle-tendon junction of the biceps brachii (see BY Shoulder Injury MTG for bicipital tendinitis and shoulder ruptures). It frequently happens while using a lot of force, especially if you’re not used to it.

Non-radiating pain at the muscle-tendon junction is the only symptom, and paraesthesias are typically absent. One of the most prevalent complaints is pain and/or mild weakness.

Although tendonitis and rupture are generally seen as two separate conditions, there is actually a lot of overlap between mild, moderate, and severe ruptures. The more severe the rupture, the more likely it is that surgery will be required to try to restore the most function, especially in individuals who are working age.

Diagnostic Criteria of Biceps Tendinosis (or Tendinitis) and Tears/Ruptures

The diagnosis of biceps tendinosis is based on a combination of the typical triggering event (typically a high force exertion, such as a maximal lift, or an unaccustomed stereotypical high force use) and the typical localised elbow pain to the affected myotendinous junctions as they insert in the distal biceps’ tendon in the distal upper arm.

Over the impacted, disturbed connections, there is focal soreness evident. Ecchymosis is a possibility and is typically inversely correlated with the severity of junctional rupture or tear. Myotendinous junctions are torn more severely in biceps ruptures, sometimes to the point where one or both of the biceps brachii are completely torn.

These ruptures are more strongly correlated with weakness in elbow flexion. The physical examination also reveals palpable anomalies, such as a biceps that feels “ropey” in the insertion location. There is frequently a hematoma in addition.

Diagnostic Studies

1. X-rays Diagnostic Studies of Biceps Tendinosis

   X-rays Diagnostic Studies of Biceps Tendinosis are recommended patients with biceps tendinosis and tears can occasionally be evaluated using X-rays, but MRI and ultrasound are more frequently employed.

   Reason for Recommendation: MRI or ultrasound are typically preferred imaging studies over X-rays, thus they should not be the first ones to be looked at. In order to rule out fracture, x-rays are especially recommended in cases of acute trauma. X-rays are non-invasive, inexpensive, and rarely cause serious side effects. They are advised as a result.

    

2. MRI for Biceps Tendinosis or Ruptures

   MRI for Biceps Tendinosis or Ruptures are recommended for ruptures or tendinosis of the biceps

   Indications – Patients whose necessity for surgery is uncertain, especially those with mild to severe biceps tendinosis or ruptures Complete rupture patients typically don’t need MRIs because they frequently don’t change the requirement for surgery

   Since the test does not change the treatment plan or the positive prognosis, patients with small tears typically do not need to get MRIs.

    

3. Ultrasound of Biceps Tendinosis

   Ultrasound of Biceps Tendinosis are recommended – for the assessment and diagnosis of ruptured or tendinosis biceps.

   Indications – Patients with moderate to severe biceps tendinosis or ruptures, especially those in whom surgery is not certain to be necessary Complete rupture patients typically do not need diagnostic ultrasonography since it typically does not change the requirement for surgery.

   Patients with minor tears typically do not need ultrasound because the procedure does not change the course of treatment or the likelihood of a positive outcome. In general, ultrasound shouldn’t be used in addition to MRI because it typically doesn’t contribute any useful information.

   Rationale for Recommendation – Diagnostic ultrasound is probably the second most popular imaging test for determining the severity of biceps tendonitis or rupture, just after MRI.

   In patients with fairly severe tears, when the degree of rupture may help determine if surgery is likely to be beneficial, ultrasound may be helpful in determining the necessity for surgery.

Medications of Biceps Tendinosis

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even if the majority of research indicates it is just marginally less effective than NSAIDs.

There is proof that NSAIDs are less dangerous and just as effective in treating pain as opioids, such as tramadol.

1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment

   Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment are recommended for the treatment of tears and biceps tendinitis

   Indications – NSAIDs are advised as treatment for Biceps Tendinosis and Tears. First, try over-the-counter (OTC) medications to see whether they work.

   Frequency/Duration – Many patients could find it reasonable to use as needed.

   Indications for Discontinuation – The easing of elbow pain, a lack of effectiveness, or the appearance of side effects that require stopping the treatment.

    

2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

   NSAIDs for Patients at High Risk of Gastrointestinal Bleeding are recommended Misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors are commonly used together by individuals who are at high risk of gastrointestinal bleeding.

   Indications – Cytoprotective drugs should be taken into consideration for patients with a high-risk factor profile who also have indications for NSAIDs, especially if a prolonged course of treatment is planned. Patients who have a history of gastrointestinal bleeding in the past, the elderly, diabetics, and smokers are at risk.

   Frequency/Dose/Duration – H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. It is generally accepted that there are no significant differences in effectiveness for preventing gastrointestinal bleeding.

   Indications for Discontinuation – NSAID intolerance, the emergence of negative side effects, or stopping use

    

3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

   NSAIDs for Patients at Risk for Cardiovascular Adverse Effects are recommended Acetaminophen or aspirin tend to be the safest medications for cardiovascular side effects when used as first-line therapy,

   If necessary, non-selective NSAIDs are preferred to COX-2-specific medications. To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in individuals receiving it for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or eight hours before the daily aspirin.

    

4. Acetaminophen for Treatment of Elbow Pain

   Acetaminophen for Treatment of Elbow Pain is recommended for the treatment of elbow discomfort, especially in patients who have NSAID contraindications.

   Indications – All patients, including those with acute, subacute, chronic, and post-operative elbow pain.

   Frequency/Dose/Duration – As per the manufacturer’s recommendations; can be used as required. When more than four gm/day is consumed, there is evidence of liver toxicity.

   Frequency/Duration – pain, side effects, or intolerance are gone.

    

5. Opioids for Select Patients with Biceps Tendinosis

   Opioids for Select Patients with Biceps Tendinosis are recommended for the treatment of a small number of individuals who have moderately severe to severe biceps tendinosis or ruptures, especially when the discomfort interferes with nocturnal sleep. Patients recovering from surgery are also eligible.

   Indications – Choose patients with significant pain from moderate to severe biceps tendinosis and ruptures that have not been adequately controlled by conventional treatments, such as acetaminophen and NSAIDs, or who have NSAID contraindications.

   Patients recovering from surgery are suitable. Opioids should be used with extreme caution, and just the bare minimal number of doses should be administered because the recovery time from elbow sprains is typically brief.

   Frequency/Dose – Dosing as needed with a focus on nocturnal administration popular with many patients. Following surgery, patients could need a planned dose throughout the first few days following surgery. The majority of nonoperative patients ought to wean themselves off of opioids within seven days of the thing.

   Indications for Discontinuation − undesirable effects, use that deviates from prescription consumption guidelines, and pain relief that is adequate to avoid the need for opioids.

   Rationale for Recommendation – In the acute postoperative phase, many patients will need treatment with opioids for a few days to no more than one week, although non-operative people typically need not.

   Opioids may be necessary for patients with moderately severe to severe biceps tendinosis or with insufficient NSAID control. They are advised for usage in specific patients for a brief period (no longer than one week).

Treatments Biceps Tendinosis

Initial Care

Evidence for Opioid UsePatients with severe or whole ruptures should be sent to a surgeon to determine whether surgical repair is necessary. Treatment for other patients should include activity restrictions and methods for managing pain that typically revolve around NSAIDs.

Monitoring Progress

Every seven to fourteen days, patients should undergo another evaluation to determine their progress. Diagnostic testing (see above) and/or referral for potential surgical repair should be taken into consideration if there is a lack of progress.

Rehabilitation: Devices / Therapy
Rehab (supervised formal therapy) needed after a work-related injury should be concentrated on regaining the functional ability needed to meet the patient’s daily and work obligations and enable them to return to work, with the goal of returning the injured worker to their pre-injury status to the extent that is practical.

Active therapy calls for the patient to put in an internal effort to finish a particular activity or assignment. The procedures known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their side.

Passive therapies are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Over passive interventions, active initiatives should be prioritised.

To sustain improvement levels, the patient should be advised to continue both active and passive therapies at home as an extension of the therapeutic process.

One further step that can be taken is using assistive technology. included into the treatment strategy to promote functional improvements.

Exercise of Biceps Tendinosis

To preserve as much of a normal range of motion during recovery as is physically possible, patients are frequently told to undertake modest range-of-motion exercises many times per day within a pain-free range.

However, excessive stretching has to be avoided when the body is going through the acute healing phase. The acute healing phase should also be free of strong or fairly heavy forceful use. Interventions are also made available to address changes in ADL and IADL performance.

Therapy (Active) of Biceps Tendinosis

Exercises for Biceps Tendinosis, Ruptures, or PostOperative Patients

Exercises for Biceps Tendinosis, Ruptures, or PostOperative Patients are recommended for the treatment of biceps tendinosis, ruptures, and post-operative patients, strengthening exercises are recommended.

Indications – Patients with biceps tendinosis are all eligible.

Frequency/Dose/Duration – With verification of continued objective functional progress, the total number of visits may be as low as two to three for individuals with minor functional deficits or as high as 12 to 15 for those with more severe deficits.

If there is evidence of functional improvement toward particular objective functional goals (e.g., enhanced grip strength, key pinch strength, range of motion, or improving capacity to execute work activities), more than 12 to 15 visits may be necessary to address persistent functional impairments.

A home exercise regimen should be created as part of the rehabilitation strategy and carried out alongside the therapy.

Duration – Depending on the severity, preinjury conditioning, and employment requirements, varies greatly.

Devices of Biceps Tendinosis

Slings and Splints for Biceps Tendinosis, Ruptures and Post-Operative Patients

Slings and Splints for Biceps Tendinosis, Ruptures and Post-Operative Patients are recommended for the treatment of post-operative patients, ruptures, and biceps tendinosis.

Indications – Patients who are moderately to severely impacted, especially during the first week. Additionally, post-operative patients are frequently given posterior splints to wear for around two weeks (range one to six weeks).

Duration- Ideally, usage should be gradually reduced to fewer than seven to 10 days. For non-operative patients wearing a sling or splint, range-of-motion exercises for the elbow and shoulder are advised many times daily to prevent postoperative problems brought on by restricted ranges of motion.

Surgery of Biceps Tendinosis

A ruptured biceps may occur in cases of biceps tendinosis that are severe enough. These suggestions are for a ruptured distal biceps tendon, not a ruptured (proximal) bicipital tendon, which occurs in the shoulder’s bicipital groove and frequently does not require surgery.

Distal biceps tendon ruptures can be treated nonoperatively, and some writers highlight that non-operative treatment is still preferred by certain patients, particularly those with older patients or modest job demands.

However, distal biceps ruptures typically happen when there has been supramaximal usage of force and must be surgically repaired in most patients who are working. Operative techniques include endoscopic, double-incision, and single-incision.

Surgical Repair for Distal Biceps Ruptures

Surgical Repair for Distal Biceps Ruptures

Surgical Repair for Distal Biceps Ruptures are recommended ruptured distal biceps can be repaired surgically.

Indications – Complete, massive, or in some individuals with moderately severe biceps tendinosis who do not satisfactorily improve with non-operative treatment, biceps tendon ruptures

Demonstrated adherence. Patients who have significant physical demands for their jobs but just mild tears are also candidates for surgery in an effort to regain enough function to resume those duties.

What our office can do if you have Biceps Tendinosis (or Tendinitis) and Tears/Ruptures

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.