Long Head of Biceps Injury: Treatment Options and Decision Making

Background: Injuries to the long head of the biceps tendon (LHB) are common and can significantly affect shoulder function and quality of life. The LHB tendon is essential for shoulder stability and movement, originating from the supraglenoid tubercle and attaching to the superior labrum. Injuries may occur due to acute trauma, chronic overuse, or degenerative changes, often resulting in pain, weakness, and a characteristic deformity known as the 'Popeye sign.' Accurate diagnosis is crucial, as symptoms may overlap with other shoulder pathologies. Treatment options vary widely based on the severity of the injury, the patient's age, activity level, and specific functional needs. Methods: This study examines treatment strategies for LHB injuries, categorizing them into conservative and surgical options. Conservative management typically includes rest, ice, physical therapy focused on strengthening and improving range of motion, and pain management with non-steroidal anti-inflammatory drugs (NSAIDs). If conservative measures fail or if the injury is severe, surgical interventions such as bicep tenodesis or tenotomy may be considered. Bicep tenodesis involves reattaching the tendon to another site on the humerus to relieve pain while preserving function. In contrast, tenotomy entails cutting the tendon to allow for its retraction, which may be suitable for older patients or those with lower functional demands. Results: Findings suggest that conservative treatment is often effective for many patients with LHB injuries, particularly in older individuals who may not require full strength. Rehabilitation usually takes several weeks, focusing on regaining mobility and strength through targeted exercises. Surgical intervention is reserved for cases where conservative management fails or when patients experience significant symptoms such as debilitating stiffness or persistent pain. Tenodesis has emerged as a preferred surgical option due to its ability to restore function while minimizing cosmetic deformity. However, tenotomy is an appropriate choice for patients prioritizing pain relief over aesthetic considerations. Post-operative rehabilitation is also crucial for recovery, emphasizing a gradual progression in strength training and functional activities. Conclusion: In conclusion, managing injuries to the long head of the biceps tendon requires an individualized approach that considers patient-specific factors such as age, activity level, and functional requirements. While many patients benefit from conservative treatments like physical therapy and NSAIDs, surgical options are available for those with persistent symptoms or significant functional impairment. Bicep tenodesis offers a modern solution that balances pain relief with functional restoration. Nevertheless, the choice between surgical techniques should be guided by a thorough assessment of each patient's unique circumstances.

کلیدواژه ها:

Long head of biceps injury ، rotator cuff pathology ، conservative treatment ، biceps tenodesis ، biceps tenotomy