x\ms~3Q4Bd2sg_[;'v{hK#* @P|sLJv;ovlb/&{XX{{u~uG`w_qa Beyond that point, the patient wears a sling for comfort and weans it after 3 weeks Clinical Goals When this tendon tears, however, the tear is usually complete and the muscle is separated from the bone and retracted back. A distal biceps rupture occurs when the tendon attaching the biceps muscle to the elbow is torn from the bone. Verywell Health's content is for informational and educational purposes only. Brace locked at 90 when not working on therapy exercises. Multiple techniques exist for tenodesis, including bone tunnels, keyhole technique, suture anchors, and interference screw fixation. Long head of the biceps pathology combined with rotator cuff tears. But biceps tendonitis is one of several possible causes of pain around the elbow.
PDF Rehabilitation Protocol for Distal Biceps Tendon Repair Dr. Awowale ACL Reconstruction ACL Reconstruction with Meniscus Repair or Microfracture Distal Biceps Repair Hip Arthroscopy Rotator Cuff Repair Protocol SLAP Repair, Bankart Repair, or Biceps Tenodesis Total Shoulder or Reverse Arthroplasty Protocol Dr. DeVries %%EOF
Do something to help reduce tension in your biceps whether its foam rolling, muscle floss, or self-myofascial release. This is indicated in higher functional level patients or athletes with extensive active pathology accompanied with other shoulder pathology such as rotator cuff tears. Pedowitz RA. It is theorized that this type of contraction remodels the collagen that makes up the tendon, helping it to heal properly. Distal Biceps Tendon Reconstruction Rehab Protocol First 10-14 days Immobilization in Splint with Elbow at 90 of flexion Encourage digital , shoulder ROM Elevation Pain Control Phase I (2 weeks to 6 weeks) Elbow immobilized in flexion-assisted Bledsoe brace with extension stop at 30 BY lH& %>!"N5KsU&.ad,,
D c$.eOO DS@ T"
Can start unrestricted strengthening as pain permits. Thats why distal biceps tendinopathy is one of the most common causes of elbow pain in lifters and athletes.
Distal Bicep Tendon Repair Protocol - Northwestern Medical Center PDF Rehabilitation Guidelines for Biceps Tenodesis Dr. James Larson is an orthopedic surgeon specializing in sports medicine and arthroscopic surgery. The Most Common Causes Of Elbow Pain While Lifting. The long head of the biceps is most commonly affected by tendinitis, as the tendon from the muscle runs up the length of the arm and attaches to the labrum (a rim of cartilage) and the shoulder blade in the shoulder joint . That far end is called distal meaning further down the limb or away from the trunk.. If any exercise causes pain to increase, you should stop performing it and check in with your PT. Save my name, email, and website in this browser for the next time I comment. Resisted IR with T-band. Structures causing primary and secondary impingement may be removed, and the biceps tendon may be repaired if necessary. STRENGTH: UBE forward and backward. (2015) Pain Medicine An Interdisciplinary Case-Based Approach. )Ed#.
Biceps Tendon Tear at the Elbow - OrthoInfo - AAOS Improve Your Form: Flaws in your lifting form can lead to significant distal biceps problems. A word of caution: K-tape is a newer treatment in PT and has not been proven to be effective in the treatment of tendon disorders. Rehabilitation of a Surgically Repaired Rupture of the Distal Biceps Tendon in an Active Middle Aged Male: a case report. Distal Biceps Repair Rehab Postoperative Distal Biceps Tendon Repair Rehabilitation Protocol PHASE I: 1-3 WEEKS For the first post op week, the patient is in a posterior splint that is not to be removed. Sports Medicine Division Physical Therapy Protocols Brad E. Brautigan MD Rehabilitation Guidelines for Distal Biceps Tendon Repair The intent of this protocol is to provide the clinician with a general guideline of the post-operative course of the patient that has undergone the above stated procedure. Human kinetic. Diagnosis of biceps tendonitis involves performing a clinical examination of your shoulder, elbow, and upper arm. Gaines MD. They have great blood flow and can repair damage from exercise quickly. The biceps muscle is located in the front of your upper arm. ~F*.`(Eflws*PVLlq[na@3Z1>,w_y^yY1vKtWp$6&]&Y7,OZ8{u*^.o^+S SPFepov=$`9~9gOgjSHPxc!WV 'h*$=DVtaS+inqS&Dm{
Sg&nUQha9yq6R'x zFcqk'h' Q[!s.||~Fp-GHGaU4n]y Demographics. Notify your PT if you get too warm during a heat treatment. J shoulder Elbow Surg March 5, 2020. Leading to an increase in pain on pull, push and overhead motions. Its a sign of overuse and your body is telling you that it needs a rest. Return to Work Following a Distal Biceps Tendon Repair: a Systematic Review of the Literature. Tests commonly performed during an evaluation for biceps tendonitis include: Once your PT has assessed your condition and completed the evaluation, they will discuss your plan of care with you. Rehabilitation of biceps tendon disorders in athletes.
PDF Distal biceps tendon repair early mobilization: Salyapongse - UW Health So be sure to check with your coach or trainer if you develop tendinitis of any kind. When a direct current that is also negatively charged is applied to the medicine, it repels it, driving the drug into your tendon. JOSPT. Apply ice packs for 10 to 15 minutes every few hours to reduce inflammation and pain. The long head inserts at the top of the socket and the short head inserts adjacent to the socket on the coracoid process of the scapula.
Distal Biceps Tendonitis | Upswing Health ruptures tend to occur in the dominant elbow (86%) of men (93%) in their 40s. If you have pain in the front of your shoulder, you may have biceps tendonitis. Begin active elbow flexion and supination at 6 weeks post-op. stream
Biceps tendonitis may be difficult to diagnose, as other conditions may present as anterior shoulder pain. Gently bend your wrist back so that your fingers point down toward the floor. Often, but not always, people feel: The elbow will usually continue to work after a biceps tendon rupture because there are other muscles that help with this motion.
Distal Biceps Tendon Injury: An Overview - HSS.edu The main cause of biceps tendonitis is simply overuse or over-training. Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.
Distal Biceps Tendon Repair Rehabilitation Protocol %PDF-1.5
Proximal bicep tendonitis: This is when there is inflammation. The biceps bends your elbow (flexion) and twists your forearm to turn your palm upward (supination).
Biceps/Triceps tendon injuries - Overview - Mayo Clinic Orthopedics Nakata W, Katou S, Fujita A, Nakata M, Lefor AT, Sugimoto H. Salim M. Hayek,Binit J. Shah,Mehul J. Desai,Thomas C. Chelimsky. Other measures like bracing or physical therapy can help decrease inflammation. Download Distal Biceps Tendon Repair Rehab Protocol First Post-Op Visit: Sling and Splint all times 2-6 Weeks: Please make patient removable extension block splint at 45 Begin Active Assist ROM. complete distal biceps avulsion. The heat increases blood flow to the area, bringing in oxygen and nutrients and flushing out waste material that may have gathered as a result of inflammation. Biceps pulley: normal anatomy and associated lesions at MR arthrography. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Clinical Physio. Tears occur secondary to unexpected extension forces and are typically associated with a "pop". Surgical Reverse Bankart & Posterior Labral Repair. The biceps also play a very important role in rotating your forearm during activities such as turning a screwdriver or doorknob. Surgical Massive Rotator Cuff Repair protocol. During this session, your PT will interview you about your injury. Gentle pulley while limiting elbow extension to -10 degrees. This can help decrease pain and improve localized circulation. You can also try these exercises at home: Distal Biceps Tendonitis. Diagnosis and determination of a plan of care is important early on if surgical treatment is necessary. stream
<>
The most common surgery for bursitis is a bursectomy, which removes the inflamed bursa to help relieve pain and promote healing. Available from: Park SS, Loebenberg ML, Rokito AS, Zuckerman JD. Shoulder Passive, Active Assisted, and Active Range of motion as tolerated all planes. Icing can also be effective. The tape is used to decrease pain and spasm or to facilitate proper muscle function. endobj
Heat can also be used to decrease pain and improve tissue mobility.
Use of Blood Flow Restriction (BFR) Therapy in Post-operative Your muscles adapt to exercise by getting bigger and stronger. Physical Therapy: Therapists can use methods such as ultrasound, dry needling, TENS, IASTM, and more to help relieve pain. Thank you, {{form.email}}, for signing up. endobj
Nonoperative treatment of distal biceps tendon ruptures - PubMed }{/2qD$ tCo}*>>fOhkb")'"'%#56B%}+,Q_o NDx? By Brett Sears, PT re^
9W,F^.?Vez1`+^;qvfB\>9ek7x9V+S\yqXX5T|RMkC|R;sbZ9 }&lzDJzb7A;tWj$P
mn(UqhrRx:ixv qvw`?IV]OU;gR4\2`Zxr+Q6 }
|(IIi[B2I6V"^YvC7
EdL}:bcwS79EQB57\Gx0r02gCbKi#`yQVYxOK,=qf8K
Best Exercises for Biceps Tendonitis - WebMD Distal Biceps Repair Distal Triceps Repair Latarjet (Traditional and Accelerated) Medial Epicondyle ORIF Pectoralis Major Tendon Repair Posterior Shoulder Stabilization Reverse Total Shoulder Arthroplasty Return to Throwing (Softball) Rotator Cuff Repair (Large to Massive) Rotator Cuff Repair (Small to Medium) Arthroscopic_SLAP_Repair If the pain caused by tendonitis or bursitis continues despite more conservative treatment options such as physical therapy, surgery may be the most effective option. If you have pain that starts as soon as you lift, or if it persists after you are done, it's time to shut that muscle down. Tendinopathy of the biceps can be painless early on. It's a sign of overuse and your body is telling you that it needs a rest. The long head of the biceps originates from the supraglenoid tubercle of your shoulder joint and is encased in a synovial sheath.
Physical Therapist's Guide to Biceps Tendon Rupture It is attached to the bones of the shoulder and elbow by tendons strong cords of fibrous tissue that attach muscles to bones. But the biceps is a pretty important one. Your doctor may prescribe a nonsteroidal anti-inflammatory medication (NSAID), like aspirin or ibuprofen, for pain relief and to reduce swelling. 2018;:1-11. doi:10.1080/09593985.2018.1488023, Zeinali A, Rahimdel A, Shahidzadeh A, Shahidzadeh A, Mellat A. This state of the art facility offers the latest in orthopedic, plastics, pain management, urology and podiatry technique set by high qualified surgeons. But dont use them to mask the pain while you keep working out. 4 0 obj
The brace itself will be used for passive range of motion.Biceps Curl Hold a light weight (about 5 to 8 pounds), a . A debate persists regarding the role of the long head of the biceps in the function of . 1 0 obj
If you think youve torn your biceps tendon, you should see a surgeon right away!
Single approach versus double-incision technique for the repair of Be sure to check out sour complete post on the subject of elbow pain below. The median duration of follow-up was thirty-eight months. The best way to diagnose biceps tendinopathy, is by comparative palpation of the biceps tendon along the intertubercular groove, or otherwise by doing a ultrasonography (extra-articulair). The diagnostic criteria for biceps tendinopathy were defined as meeting at least one of the following: All involved with the musculoskeletal US examination reached a consensus on these diagnostic criteria for the purpose of avoiding operator-dependent misdiagnosis.[2]. The continuum of clinical pathology ranges from acute inflammatory tendinitis to degenerative tendinopathy. Clin Sports Med. Potential factors predisposing to biceps-related shoulder injuries include glenohumeral internal rotation deficit (GIRD) in overhead-throwing athletes/baseball pitchers, poor trunk control, scapular dyskinesia, and internal impingement. Stuart Hershman, MD, is a board-certified spine surgeon. If your PT chooses to use e-stim for your biceps tendonitis, two to four small electrodes will be placed around your shoulder and upper arm, and electricity will be applied to the electrodes. In addition to the diagnostic criteria, increased color flow signals were recognized around the swollen biceps tendon as essential to a biceps tendinopathy diagnosis. Surgical Biceps Tenodesis. This condition can make using your arm for normal work and recreational activities difficult. Talk with your PT about how long your specific condition is expected to last. Hamilton Orthopaedic | All Rights Reserved | Design by. The physical therapist must consider both the patient's subjective response to injury and the physiological mechanisms of tissue healing; both are essential in relation to a patients return to optimal performance. Patients are usually seen at 1 week post op, then at 5-6 weeks post op. Distal biceps tendon ruptures occur primarily in males and risk factors include smoking, corticosteroid use, and anabolic steroid use. If you have pain in the front of your elbow when lifting, in the little hollow, it could be distal biceps tendinopathy. Stand in front of a wall with a 6-inch distance and raise your injured arm palm down below your shoulder's height. Research has shown this to provide sufficient reductions in pain levels while maintaining normal biceps function. Exercise has been shown to help improve ROM, strength, and functional mobility to your arm and shoulder. The retractedbiceps tendon is retrieved through the incision. Biceps light isotonics progressing 1 pound per week beginning at week 12 weeks post-op. These join into a single tendon that crosses the elbow and attaches to the radius, a bone in your forearm.
%
A tendon is a band of connective tissue that attaches muscles to the bones. Distal biceps tendon fixation techniques: There are various options to fix the distal biceps tendon. A small incision is made over the upper forearm, where the biceps should attach onto the radius bone. This tendon stretches along your biceps muscle from your elbow up to your shoulder. Treatment of Distal Biceps Tendinopathy Rest: The most important way to treat biceps tendinitis is to give your elbow a rest. 3 weeks post-op 30-115 5 weeks post-op 15-130 Biceps tendonitis is usually caused by overloading and overusing the biceps tendon. %PDF-1.7
David Smith, SPT, Missouri State University, Springfield, Missouri. Prone T, Y, and W. Shoulder extension with T-band.
Physical Therapy Guide to Biceps Tendon Rupture - Choose PT 2010 Apr;29(2):229- 46, vii-viii. Surgical Subacromial decompression protocol. Electircal stimulation may be used to help treat your biceps tendonitis or tendinopathy. Primary bicipital tendinitis is much less common than cases where it is associated with concomitant primary shoulder pathologies (i.e., secondary cases).
Bicep Tendon Tear - Physiotherapy Treatment Rest will calm the inflammation and help relieve the pain. IJSPT February 2012 vol7 issue 6 pg:663-671. Biceps tendonitis describes a clinical condition of inflammatory tenosynovitis, most commonly affecting the tendinous portion of the LHB as it travels within the bicipital groove in the proximal humerus. Alphabet door / clockwise / counterclockwise circles with ball. (third edition). Stand and hold your affected arm out to the side, with your hand at about hip level. mend nonoperative treatment of distal biceps tendon ruptures for people who are wary of surgery or present late with the injury.11 CASE c Two orthopedic surgeons examined our patient and both supported our recom-mendation to pursue conservative treatment for mr. a. over the next 4 to 6 weeks, he received physical therapy 2 to 3 times per week. 2012;2012:405472. A biceps tendon rupture usually occurs when the tendon tears away from the forearm bones. Care should be used, since ice placed directly on your skin may cause a frost burn. Passive elbow extension exercises may be started if needed. Your practitioner may order diagnostic tests like magnetic resonance imaging (MRI) to view the soft tissue structures around your shoulder. That includes shoulder strength too. v"#1F2=aqTK-.J |-[Hx\ cpZj0+5+ajV2ecYS4h1SNrBdj?
Bicep tendonitis elbow: a common injury in gym-goers - Sport Doctor London Since it is a new treatment, little research has been done regarding dry needling.
Most commonly, the biceps tendon is torn at the shoulder.
Biceps Tendinitis: Exercises - Alberta These may include a rotator cuff tear, AC joint arthritis, shoulder labrum injury, or cervical (neck) radiculopathy. Notify your PT if you feel any pain so adjustments can be made. There are several muscles that help with both of these. Our team of highly renowned orthopedic specialists and surgeons focus on advanced sports medicine, spine, joint replacement, shoulder, elbow, foot, ankle and much more. Other elbow conditions: Common elbow, hand, and wrist conditions Tennis elbow Protocol DISTAL BICEPS REPAIR INTRODUCTION The biceps tendon ruptures off the forearm bone (radius) and retracts into the upper arm, causing a deformity andweakness. 0
Guide | Physical Therapy Guide to Biceps Tendinitis | Choose PT [1], Differential Diagnosis of Anterior Shoulder Pain:[4], Due to the lack of specificity in differentiating between biceps tendon pathology, subacromial impingement syndromes, and rotator cuff pathology, it is important to take an extensive history upon evaluation and not use these tests solely to make a diagnosis[6]. You may also do this next to a wall and rest your fingers on the wall. As a preface to discussion of the goals of treatment during injury rehabilitation, two points must be made: Biceps tendinopathy is an inflammation that can be caused by the normal ageing process as well by a degenerative process which usually occurs in athletes with repetitive overhead movements. Keep your arm straight and hold for 15 seconds. needs to learn more about biceps tenodesis and rehabilitation we recommend reading: Krupp RJ. It can also help improve circulation to the tendon and help facilitate healing. The biceps muscle has two tendons at the shoulder. Patient should perform passive ROM exercises from 30 degrees of extension to 130 degrees of flexion 5-6 times per day for 25 repetitions. hbbd```b``z"WIGbfkem$/d l/0,r>&p$'W[20m @g`` 33
A distal biceps rupture is rare compared to ruptures where the top of the biceps connects at the shoulder. Treatment consists of conservative or surgical treatment. Passive supination and pronation stretch. <>
The treatment involves passing an ultrasound wand with a coupling gel over your injured tissue for five to 10 minutes. ntYDSp6t^=p. Your biceps muscles are located in the front of your upper arms. He started LSO to keep more people moving better, longer. Surgical management of biceps tendinitis includes removing the long head of the biceps tendon via arthroscopic tenodesis. Biceps tenodesis has traditionally been performed through the deltopectoral interval to visualize the retracted tendon distally in the groove.
Distal Biceps Rupture - Physical Therapy in Baton Rouge But it will feel weak and heavy.
Distal Bicep Tendon Rehabilitation Exercises - Health | NoahStrength.com May continue bicep curls progressively add resistance. When the lining becomes inflamed, the tendon cannot glide smoothly in its covering (sheath). A burning sensation may be felt if ultrasound is not applied properly. Golfers Elbow Braces and Rehab Equipment, Bulging, shortened appearance of the biceps. Go to: Differential Diagnosis The diagnosis of the biceps tendon rupture sometimes is challenging. RICE therapy (rest, ice, compression, elevation) may reduce the severity of symptoms. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
6xB3:at1cu" &sDVz9P fHC )C&6_
qHj)Mi?u=Nqi\F(HuCBS+k8S5as= 4rnOD0$U.s\{=G|?W/aw0j%%|tc_f>n(bC$+pridgyq^Oy}yTI0#d?%#?V]PBc~>@sO.;1|1! 10. In 1982, Neviaser et al. endstream
endobj
startxref
This is localized to the hollow in the front of your elbow or sometimes just below there, in the forearm. Listed below are physical therapy (PT) protocols categorized by physician. Your email address will not be published. xko{~r, v^M-dIg[X+rz e.gvv37cy=/g.v:/#^KUo_ Other more invasive treatments for persistent biceps tendonitis may include cortisone injections, platelet rich plasma injections, or surgery. Horschig et al. But dont worry; Ill tell you what it is, how you probably got it, how to help get rid of it! 2 Boston Medical Center, Boston, MA, USA. Ice for 10 minutes every hour for the first couple days after the injury may be recommended. It is by no means intended to be a substitute for one's clinical decision making .
Easy Ways to Treat Bicep Tendonitis: 12 Steps (with Pictures) - wikiHow Surgical Rotator Cuff Repair protocol. Various exercises may be included in your biceps tendonitis rehab program, including: Shoulder ROM exercises. Wrist and hand gripping exercises. Proximal biceps tendinitis and tendinopathy, https://www.ncbi.nlm.nih.gov/books/NBK533002/.
Distal Bicep Rupture | Bicep Tendon Tear Rehab (Without Surgery) 199 0 obj
<>stream
Biceps tendonitis - Mayo Clinic Orthopedics & Sports Medicine <>
Larson Sports & Orthopaedics. During the first week and up to about the third week, range of motion exercises will be performed in the brace. Methods: Eighteen patients with twenty unrepaired distal biceps tendon ruptures were assessed retrospectively. During the PT evaluation for biceps tendonitis, your physical therapist will perform various tests and measures.
PDF Biceps Tendon Strengthening Exercises - Jaspal Ricky Singh, M.D Distal Biceps Tendon Repair Protocol Phase I ( 0-7 days post-op): Posterior splint at 90 degrees of elbow flexion. Restoring a pain free range of motion - Pain free range can be achieved with such activities as PROM, Active-Assisted Range of Motion (AAROM), and, Painful activities such as abduction and overhead activities should be avoided in the early stages of recovery as it can exacerbate symptoms. Physiother Theory Pract. The 4 minute video below shows the classic presentation of long head of biceps (LHB) tendinopathy. Return to lifting: Take it slowly. So over time, your tendons can accumulate a lot of damage while working out, eventually leading to problems. Since Hamilton Orthopaedics, Spine and Sports Medicine was founded by Dr. Ivan Gowan in 1984, the practice has grown exponentially to serve the ever growing demand in Central New York. stream
While you're dealing with pain from an inflamed bicep tendon, fill an ice pack with ice and hold it against the area that's hurting for up to 20 minutes.
Tendinopathy Rehabilitation - Physiopedia - universal access to demonstrated the relationship between increasing LHB tendon inflammatory changes with increasing severity of rotator cuff (RC) tendinopathy. With the personal attention that comes from our being part of a smaller community. All of our locations are handicapped accessible. ACL Reconstruction Rehabilitation Protocol, Bankart Repair or Anterior or Posterior Labral Repair, Medial Patellofemoral Ligament Repair/Reconstruction, Rotator Cuff Repair Rehabilitation Protocol. International Journal of Clinical Medicine.
9. But over time, it can cause pain, loss of strength, and difficulty flexing your elbow. He supports weight training and high-intensity exercise throughout the lifespan. Surgical treatment options . Our doctors also perform some procedures at UHS Chenango Memorial Hospital as well. Rehabilitation Guidelines for Biceps Tenodesis This protocol is intended to guide clinicians through the post-operative course for biceps tenodesis. Your PT will also ask about your medical history and may review any medication that you are taking. Shoulder ROM exercises are encouraged. Distal bicep tendonitis: This is when inflammation occurs at the end of the tendon connecting the biceps muscle to the elbow. Most cases can be treated successfully in about four to six weeks. It also plays a role in shoulder function. Surgical procedures are performed in the ultra-modern surgical suites at Community Memorial Hospital in Hamilton. endobj
Baechle. During tissue healing, controlled therapeutic stress is necessary to optimize. Rotate your body in the opposite direction of the raised arm until you feel a stretch in your biceps. Initially Limit Extension to 45, Advance to full extension by 6 weeks Splint all times other than exercises Wrist/Shoulder ROM exercises 6-9 Weeks: Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Everyone likes to have nice, toned arms. Functional progression to athletic activity. Putty may be used 3 times per day to improve grip strength. The biceps muscle helps to decelerate your elbow as it is extending, and overusing it in repetition may place excessive stress on the tendon, leading to inflammation. Read our, Physical Therapy Evaluation for Biceps Tendonitis, Physical Therapy Treatment for Biceps Tendonitis, Therapeutic Ultrasound in Physical Therapy, Physical Therapy for a Pectoralis Major Tear, KT Tape for Rotator Cuff and Shoulder Injuries, At-Home Exercises and Physical Therapy for Calcific Tendonitis, Causes of Shoulder Pain and Treatment Options, First Steps to Help Treat a Frozen Shoulder, Exercises to Improve Stability After a Shoulder Labrum Tear, Causes of Elbow Pain and Treatment Options, transcutaneus electic neuromuscular stimilation (TENS), neuromuscular electrical stimulation (NMES), Treatment of individuals with chronic bicipital tendinopathy using dry needling, eccentric-concentric exercise and stretching; a case series, Comparison of the Effects of Kinesio Taping to Local Injection of Methyl Prednisolone in Treating Brachial Biceps Tendonitis, Tenderness to touch in the front of your upper arm and shoulder. Improve Your Core Control: As Ive discussed in other articles, core strength and control are extremely important in preventing extremity injuries. 5_:D`m_SP#W##F'I|nA The biceps muscle is responsible for bending (flexing . Thus, concomitant or preexisting RC pathology can directly compromise the LHB tendon itself. If these simple steps are ineffective, other treatments such as cortisone injections, needle tenotomy, or PRP injections are possible.