Efficacy of conservative treatment strategies for partial distal biceps tendon ruptures: a case-control study

Abstract

Background: Partial distal biceps tendon tears (PDBTs) are uncommon injuries that present with a range of symptoms, from mild pain to significant weakness. The optimal treatment approach for PDBTs remains debated, with a lack of consensus regarding the most effective nonoperative strategies. This study compares three nonoperative treatments: wait-and-see, physiotherapy, and injection therapy, to determine their efficacy and identify factors influencing treatment outcomes. Materials and methods: This retrospective study included 78 patients diagnosed with partial distal biceps tears from January 2017 to December 2024. Diagnosis was confirmed through clinical examination and magnetic resonance imaging. Patients were treated with one of three nonoperative strategies: a wait-and-see approach, standardized physiotherapy, or ultrasound-guided injection therapy. Functional and clinical assessments, including the Mayo Elbow Performance Score and visual analog scale for pain, were conducted at 3-and 6-months post-treatment. Results: The overall success rate for nonoperative treatment at 6 months was 47%, with no significant difference between the treatment groups (injection 50%, physiotherapy 46%, wait-and-see 46%). Injection therapy resulted in the fastest symptom relief, with most patients reporting improvement within one week. No patients progressed to complete ruptures, and those requiring surgery after treatment failure achieved full resolution. Multivariable analysis showed no significant impact of factors like inflammatory disease, diabetes, profession, smoking, grading of the tear and lesion origin (trauma vs. attrition) on treatment outcomes. Conclusion: Nonoperative treatment for PDBTs, including injection therapy, physiotherapy, and a wait-and-see approach, yields moderate success rates. Injection therapy offers the quickest relief with no detrimental effects. Surgery remains an effective option for treatment failures. Level of evidence: Level III; Retrospective Cohort Comparison; Treatment Study (c) 2025 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights are reserved, including those for text and data mining, AI training, and similar technologies.