Long Head of Biceps Tendonopathy

Referrals for USS guided steroid injections to RCHT Clinical Imaging have restarted.  Please note there is limited capacity so referrals should be reserved for patients with significant disabling and persistent symptoms.  Please click here for full details

Covid-19 Update: Corticosteroid Injections During The Coronavirus Pandemic 

"Please note that any patients considering steroid injections during the Coronavirus pandemic require a risk assessment and counselling on increased risks with Covid prior to performing.  Secondary care referrals for steroid injection, including image guided injections, require the patient to be counselled and risk assessed prior to referral and this documented in the referral.  Please see guidance available here for detailed information."

Commonly associated with, or a manifestation of, impingement.

Primary care management:

·         Rest, Ice, Analgesia

·         Physiotherapy

·         Steroid injection – trial of 2 injections

 

Indications for referral

·         Failure of primary care management as above

·         Severe tendinopathy 

 

Consider referral to the MSK Interface service if:

·         Diagnostic uncertainty

·         Conservative measures have failed

·         An USS guided corticosteroid injection may be performed

·         Please include a copy of a recent shoulder XRAY report with the referral

 

Consider referral to Orthopaedics if:

·         Chronic symptoms not responding to conservative measures above

·         Severe tendinopathy

·         Please include a copy of a recent shoulder XRAY report with the referral

·         Patients over 40 yrs old also require a shoulder USS prior to referral

  

Discussion points

Rupture of the long head of biceps in older patients does not usually require treatment but may indicate significant impingement or a cuff tear. If referring to Orthopaedics please organize a shoulder XRAY and USS and enclose results in the referral letter. 

 

Date reviewed                     11/03/2022

Next review due                  11/03/2023

Sifter name                          Dr Rebecca Hopkins

 

Consultant name + any other contributors           Mr Sean Dixon, Mr Jeremy Dainton, Ms Annie Rae, Ms Deanne De Beer, Dr Katy Bray, Dr Rebecca Hopkins

Version 1.1