Physical Therapy Utilization Prior to Biceps Tenodesis or Tenotomy for Biceps Tendinopathy.
Amy McDevitt, Joshua Cleland, Paisley Hiefield and 2 others
PMID 39502549WHAT IT FOUND
Most patients seeking biceps surgery had not tried physical therapy.
Among those who did, therapists used more active exercises than passive modalities. This describes current practice but cannot show if treatment prevented surgery or worked.
Key findings
01Only 20.1% of eligible patients attended physical therapy for shoulder pain within two years prior to biceps surgery.
02When physical therapy was provided, 54.5% of billed procedures were active interventions like therapeutic exercise, compared to 45.5% passive interventions like manual therapy.
03The median number of physical therapy visits was four, with 64.5% of patients attending four or more visits.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study only included patients who had surgery. It cannot report on patients who tried physical therapy and improved enough to avoid surgery, so it is impossible to know if PT was effective for those individuals. Physical therapy provided outside this specific hospital system was not tracked, so some patients may have had conservative care that was missed. The study relied on billing codes and chart notes, which may not capture the full clinical picture or the quality of the intervention delivered. The sample size of patients who actually received PT (62) is small, limiting the generalizability of the specific intervention patterns. Diagnosis was based on surgical procedure codes and patient records, not strict clinical diagnostic criteria for isolated biceps tendinopathy, and many patients had concurrent shoulder pathologies.
Declared interests
The work was supported by The American Academy of Orthopedic Manual Physical Therapists (AAOMPT) under a grant from Cardon Rehabilitation. The authors state that neither the academy nor the funding agency had a role in the study design, analysis, interpretation, or decision to publish.
The easy way to misread this
Do not interpret the high rate of surgery in patients who did not receive PT as evidence that PT is ineffective for biceps tendinopathy. This study cannot assess efficacy because it only looked at patients who chose surgery, excluding those who may have recovered with conservative care.