This may start with isometric training if pain is the primary issue progressing into eccentric training and eventually concentric loading as with other forms of tendon rehab. 2 Boston Medical Center, Boston, MA, USA. They course from two heads (hence the name "biceps") near your shoulder joint. Active extension limit changed to 10 degrees. %%EOF Be sure to check out sour complete post on the subject of elbow pain below. All of our locations are handicapped accessible. Apply ice to the injury for 10-20 minutes, 3 times a day, for the first 3 days. Distal Biceps Tendon Injury: An Overview - HSS.edu Distal Biceps Tendon Repair - REHABILITATION PROTOCOL Michael B. Gerhardt, M.D. 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. Putty may be used 3 times per day to improve grip strength. These exercises can help you maintain gains that you achieve in the clinic. Other elbow conditions: Common elbow, hand, and wrist conditions Tennis elbow % Ladder with arm supported by unaffected extremity. Surgical Massive Rotator Cuff Repair protocol. Distal Biceps Tendon Repair Rehab Protocol. As the pathophysiology escalates, there is an ensuing LHB sheath thickening, fibrosis, and vascular compromise. Other measures like bracing or physical therapy can help decrease inflammation. Your doctor may prescribe a nonsteroidal anti-inflammatory medication (NSAID), like aspirin or ibuprofen, for pain relief and to reduce swelling. If you have pain in the front of your shoulder, you may have biceps tendonitis. Surgical Bankart & Anterior Labral Repair. The vast majority of cases are seen in association with the aforementioned shoulder pathologies. Wrist and hand gripping exercises. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Larson Sports and Orthopedics is a group made of a surgeon, athletic trainer, and experienced HIIT Coaches who specialize in orthopedic sports medicine including anatomy and physiology, injury prevention, and orthopedic surgery/rehabilitation. Shoulder rotator cuff and scapular strengthening. BayCare Clinic is a joint partner in Aurora BayCare Medical Center, a 167-bed, full-service hospital. The muscles and tendons of the rotator cuff hold the ball into the socket of the shoulder. Surgery should be considered if conservative measures fail after three months. Call for an appointment (03) 6231 2477. FAQs and information from BayCare Clinic. Rest: The most important way to treat biceps tendinitis is to give your elbow a rest. These injuries often require surgical treatment. Be sure you understand what to expect from iontophoresis, and speak with your physical therapist if you have any questions about it. Your biceps muscles are located in the front of your upper arms. Thank you, {{form.email}}, for signing up. K(-fr By Brett Sears, PT Plymouth Distal Biceps Repair Rehabilitation Protocol 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 This thickening of the ligament may cause abnormal rubbing on the tendon, leading to inflammation and irritation. Our doctors also perform some procedures at UHS Chenango Memorial Hospital as well. Save my name, email, and website in this browser for the next time I comment. Interested in joining our wonderful team at Hamilton Orthopedics? 4 0 obj Cross-friction massage may be done to stimulate collagen formation around your injured tendon. Biceps tendonitis is usually caused by overloading and overusing the biceps tendon. Passive flexion may be increases to full. Phase I: 1-3 weeks Clinical Goals Elbow ROM from 30 of extension to 120 of flexion (this may vary depending on patient's situation. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Be sure the heat does not burn your skin; a few layers of toweling should be placed between the hot pack and your skin. x=ioCG)Q }NvdwyXIqlOlw_uP%R6,UbQ>|ZMjU>ckq?|vf~.qtq0_.z |~7{W w_ zSiH%YHhyNM%^N/sN|u@f$NE^)z'eLp[s;}yDf`@jArL"{1J?=Y2hHj#j3bA\8W?#|dot\qCFpzO bo$>gc{7XzFcoJ 8ylU'BYn3x=r=R@y/W0j-|4m.dV)gc+JghGS2znpT2zxBpC- 0nu|Y&AXqJdV(H|(iRyM@b9P{8g:9.87J Mr@}ar+W o+T*# ]kVxpg"xSP?Fq =!9pP=vGY(3~ Jt There is a ligament that courses over the long head of the biceps tendon, and this may thicken as you age due to repeated micro-trauma to the area. But that takes a lot of work. 3 Massachusetts General Hospital, Boston, MA, USA. Rotate your body in the opposite direction of the raised arm until you feel a stretch in your biceps. Everyone likes to have nice, toned arms. Healing tissue must not be overstressed and a very slow heavy loading program should be undertaken. 2 0 obj Distal biceps tendon fixation techniques: There are various options to fix the distal biceps tendon. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. Initiate resisted wrist supination and pronation. If you have pain in the front of your elbow when lifting, in the little hollow, it could be distal biceps tendinopathy. Kotara S. Singleton SB. Undergoing distal biceps tendon repair Exclusion Criteria: Revision Biceps tendon repair, Irrepairable tendon injury, Biceps repairs with biologic augmentation, Patients with concomitant neurovascular injury, Inability to tolerate BFR treatment, Unable to complete full course of physical therapy, Peripheral vascular disease, Ice may be used in the treatment of biceps tendonitis. When the lining becomes inflamed, the tendon cannot glide smoothly in its covering (sheath). Distal biceps tendinopathy can also be known as distal biceps tendinosis or distal biceps tendinitis. Step 1: Allow your injured arm to hang at your side, then bend your elbow to a 90-degree. During the PT evaluation for biceps tendonitis, your physical therapist will perform various tests and measures. Improve Your Form: Flaws in your lifting form can lead to significant distal biceps problems. JOSPT. When the tendon is subjected to repetitive stresses, it can become irritated, swollen, and painful. 4 0 obj <>>> If these simple steps are ineffective, other treatments such as cortisone injections, needle tenotomy, or PRP injections are possible. Repetitive motions,. hbbd```b``z"WIGbfkem$/d l/0,r>&p$'W[20m @g`` 33 PDF Biceps Tendon Strengthening Exercises - Jaspal Ricky Singh, M.D )Ed#. Mcdevitt AW, Snodgrass SJ, Cleland JA, Leibold MBR, Krause LA, Mintken PE. Distal Bicep Tendon Repair Protocol - Northwestern Medical Center RICE therapy (rest, ice, compression, elevation) may reduce the severity of symptoms. May continue bicep curls progressively add resistance. PMID: 30997282 PMCID: PMC6449020 ER in plane of scapula. P% m@DDLw)TypU" (Pu` w 8G Diagnosis and determination of a plan of care is important early on if surgical treatment is necessary. Prospective study of three surgical procedures for long head biceps tendinopathy associated with rotator cuff tears, Tendinopathy of the tendon of the long head of the biceps, Long head of the biceps tendinopathy: diagnosis and management, Tendinopathy of the long head of the biceps, Treatment of tendinopathy: what works, what does not, and what is on the horizon, https://www.physio-pedia.com/index.php?title=Biceps_Tendinopathy&oldid=296103, Main function of the biceps muscle is forearm supination and, Biceps also contribute 10 percent of the total power in. Your muscles adapt to exercise by getting bigger and stronger. This often happens in repetitive overhead activity, such as racquet sports or when throwing a baseball. 10. Most commonly, the biceps tendon is torn at the shoulder. Physical therapy protocols - Allina Health PNF D2 flexion and extension with tubing. Best Exercises for Biceps Tendonitis - WebMD The stimulation, or e-stim, can be used to decrease pain, improve muscle function, or increase circulation. If you have pain that starts as soon as you lift, or if it persists after you are done, its time to shut that muscle down. Anti-inflammatories: Ibuprofen or turmeric can help relieve the pain as well. 3 0 obj Physical Therapist's Guide to Biceps Tendon Rupture Iontophoresis is a special form of electrical stimulation that uses electricity to administer medication through your skin and into your injured biceps tendon. Biceps Stretch. Nakata W, Katou S, Fujita A, Nakata M, Lefor AT, Sugimoto H. Salim M. Hayek,Binit J. Shah,Mehul J. Desai,Thomas C. Chelimsky. 2. distal biceps tendon rupture represents about 10% of biceps ruptures. When a direct current that is also negatively charged is applied to the medicine, it repels it, driving the drug into your tendon. This electrical impulse may tickle a bit, but it should not cause pain. Distal bicep tendonitis: This is when inflammation occurs at the end of the tendon connecting the biceps muscle to the elbow. General time frames are given for reference to the average, but individual This is called the distal biceps tendon. He started LSO to keep more people moving better, longer. [10][11] Or for more persistent presentations, corticosteroid injections along the tendon sheath may be indicated. 2017;8, 395-401. doi:10.4236/ijcm.2017.86037. %PDF-1.5 But dont use them to mask the pain while you keep working out. 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. ntYDSp6t^=p. Mobilize: Chronic excess tension in your muscles from weight training can lead to damage over time. Adv Orthop. PDF Brad E. Brautigan MD The biceps muscle is responsible for bending (flexing . Distal Biceps Tendon Repair Rehabilitation Protocol Physical therapy initially focusing on unloading followed by reloading the effected tendon (see Tendinopathy rehab page for full details). During this session, your PT will interview you about your injury. But it will feel weak and heavy. Your first appointment with a physical therapist (PT) for biceps tendonitis is called an initial evaluation. Biz C, Vinanti GB, Rossato A, Arnaldi E, Aldegheri R. Longo UG, Loppini M, Marineo G, Khan WS, Maffulli N, Denaro V. Nho SJ, Strauss EJ, Lenart BA, Provencher MT, Mazzocca AD, Verma NN, Romeo AA. A small incision is made over the upper forearm, where the biceps should attach onto the radius bone. endstream endobj 173 0 obj <. Biceps tendonitis - Mayo Clinic Orthopedics & Sports Medicine 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. 2012;2012:405472. (third edition). The etiologies for primary bicipital tendinitis are not well understood compared to the more common secondary presentations. The short head of the biceps arises from the coracoid process of your shoulder blade. Surgery to reattach the tendon is usually necessary and its best to do so within two weeks. Surgical Reverse Bankart & Posterior Labral Repair. 8. Distal Biceps Tendonitis: Causes, Symptoms & Treatment Active extension limit changed to 20 degrees. The biceps muscle has 2 tendons that attach it to the shoulder and travel the length of the upper arm and insert just below the elbow. Surgical Total Shoulder Replacement. Exercise should be your main tool in the treatment of biceps tendonitis. x\ms~3Q4Bd2sg_[;'v{hK#* @P|sLJv;ovlb/&{XX{{u~uG`w_qa Talk with your PT about how long your specific condition is expected to last. https://www.youtube.com/watch?v=j4vYM7JXSW8, Diagnosis and treatment of biceps tendinitis and tendinosis, The shoulder in baseball pitching: biomechanics and related injuries--Part 1, The long head of biceps and associated tendinopathy. [7] In low-functioning or medically complicated patients, conservative measures should always be pursued initially.[10]. . Bicep Tendon Tear - Physiotherapy Treatment Guide | Physical Therapy Guide to Biceps Tendinitis | Choose PT Methods: Eighteen patients with twenty unrepaired distal biceps tendon ruptures were assessed retrospectively. One of the primary goals of rehabilitation after a distal bicep tendon tear is to regain range of motion of the elbow. Tears of the distal biceps tendon are unusual and most often result from an injury or lifting a heavy object. Copyright 2023. Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy. In most cases Physiopedia articles are a secondary source and so should not be used as references. Easy Ways to Treat Bicep Tendonitis: 12 Steps (with Pictures) - wikiHow Start at weight and rep ranges that are very light and work your way up. Long-term biceps tendon problems are often referred to as biceps tendinopathy. stream u:d`+.nba^*E31IQRCN8x+j6TVEkDZ He also holds a CF-L1 certificate and is a Certified BFR Specialist. Physical Therapist's Guide to Biceps Tendinitis Distal biceps tendonitis is an injury that results from overuse, and continuing to use an injured tendon can cause more damage. Biceps stretch: Stand facing a wall (about 6 inches, or 15 centimeters, away from the wall). Biceps tendonitis may be difficult to diagnose, as other conditions may present as anterior shoulder pain. PDF Distal Biceps Tendon Reconstruction Rehab Protocol This is localized to the hollow in the front of your elbow or sometimes just below there, in the forearm. This injury occurs mainly in middle-aged men during heavy work or lifting. National Strength and Conditioning Association. Supine scapula stabilization with 1kg weight. Gently bend your wrist back so that your fingers point down toward the floor. Biceps tendinitis result when excessive, abnormal forces are applied across the tendon, including tension (a pulling of the muscle and tendon), compression (pushing or pinching), or shearing (rubbing). Late Stage 8-12 weeks+ Many physical therapists do not use ultrasound due to this lack of benefit. Supersedes: N/A: Or . Hamilton Orthopaedic | All Rights Reserved | Design by. <> Return to Work Following a Distal Biceps Tendon Repair: a Systematic Review of the Literature. Biceps Tendon Strengthening Exercises | Advanced Sports & Spine stream PDF Distal Biceps Tendon Protocol - Brigham and Women's Hospital Go to: Differential Diagnosis The diagnosis of the biceps tendon rupture sometimes is challenging. endobj Surgical Rotator Cuff Repair protocol. demonstrated the relationship between increasing LHB tendon inflammatory changes with increasing severity of rotator cuff (RC) tendinopathy. Conservative Posterior Instability. This tendon stretches along your biceps muscle from your elbow up to your shoulder. Light strengthening exercises are started with light Theraband or 1-kg weights for elbow flexion, extension, forearm rotation and wrist flexion and extension. Most commonly, LHB tendinopathy occurs in association with RC pathology, EI/SIS, or in tandem with subscapularis injuries. Heat and Ice: Ice can help reduce the pain, but heat is typically better to improve blood flow and help speed healing. PDF Rehabilitation Protocol for Distal Biceps Tendon Repair % Rehab Protocols. <> A sling or cuff and collar may be used for the splint or hinged brace respectively. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Notify your therapist if you feel discomfort during ice use in the PT clinic. There are many symptoms of possible biceps tendonitis. "B/_|`+BOxIQyD0r>}wKO_2{}_m_yg=^,wm~\,L) MM&"$^t)^k!Z_u Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Rehabilitation of biceps tendon disorders in athletes. So be sure to check with your coach or trainer if you develop tendinitis of any kind. In effect, the tendon becomes pathologically anchored in the groove, further exacerbating the potential points of traction and overall increasing shear forces experienced by the LHB tendon along its course. Your thumb will keep your hand in place on the wall and gently turn away from the wall, stretching your biceps as you move. Treatment for tendonitis & bursitis | TRIA Orthopedics - HealthPartners endobj Human kinetic. They should not be copied or otherwise used without the permission of the Director of Rehabilitation Services. A burning sensation may be felt if ultrasound is not applied properly. Maintain minimal swelling and soft tissue healing The medication is typically an anti-infammtory liquid that is negatively charged. In advanced, end-stage conditions, the LHB tendon can eventually rupture at its origin near the superior glenoid tubercle, or as it exits the bicipital groove near its musculotendinous junction. PDF Biceps Tenodesis Protocol - Boston Shoulder Institute It has two separate parts, or muscle bellies, which is where it gets the name bi meaning two. 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. That way, you can be sure to start on the right treatment for your condition. The resultant increased pressure and specific sites of traction predispose the tendon to pathologic shear forces. <> stream OUP USA. 0 It's a sign of overuse and your body is telling you that it needs a rest. To serve as a guide to physical therapy following your surgery, this section contains rehabilitation protocols specific to your procedure. The long head of the biceps originates from the supraglenoid tubercle of your shoulder joint and is encased in a synovial sheath. Gentle pulley while limiting elbow extension to -10 degrees. BayCare Clinic, baycare.net, is the largest physician-owned specialty-care clinic in northeastern Wisconsin and Michigans Upper Peninsula. Some physical therapists use a treatment technique called kinesiology taping, also known as K-tape. That is usually the journal article where the information was first stated. 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. Surgical: If conservative management has not been successful then surgical management can be considered. Begin co-contraction exercises of biceps and triceps. Biceps Tendinitis: Exercises - Alberta The present study was designed to assess the outcomes associated with unrepaired distal biceps tendon ruptures. Tendonitis occurs most commonly in the long head of the biceps tendon. They will ask how your injury occurred, how it is affecting your work and recreational activities, and if you have had any treatment so far for your condition. The treatment involves passing an ultrasound wand with a coupling gel over your injured tissue for five to 10 minutes. Dr. James Larson is an orthopedic surgeon specializing in sports medicine and arthroscopic surgery. Successful physical therapy regimens target the underlying source(s) contributing to the LHB tendon pathology. <>/Metadata 508 0 R/ViewerPreferences 509 0 R>> Biceps Tendonitis Exercises: Relieve Pain - healthline.com Supination/pronation through pain-free range. He specializes in spinal deformity and complex spinal reconstruction. Either through a bone tunnel, suture anchors, interosseous screw fixation, or suspensory cortical button. Final visits are usually at 12 weeks. And all those hammer curls and pull-ups can take a toll on the tendons of your arms. Plymouth Distal Biceps Repair Rehabilitation Protocol Phase 1. Tears occur secondary to unexpected extension forces and are typically associated with a "pop". 1173185, Pathological Process - Tendinopathic Cascade. 2 0 obj Iontophoresis is usually applied for 10 to 20 minutes and should be painless. Keep your arm straight and hold for 15 seconds. Leading to an increase in pain on pull, push and overhead motions. Tendinopathy Rehabilitation - Physiopedia - universal access to Your physical therapist may perform various massage techniques for your biceps tendonitis. Overloading of the biceps tendon at your shoulder or elbow may cause biceps tendonitis. PDF Distal Biceps Repair Rehabilitation Guidelines Post-Operative Distal Biceps Tendon Repair Rehab Protocol Biceps Tendon Injury Exercises: References. zy6 >E/{xT D:L=3=tCk,&S 8}f"k)7nlVanCH1XtRN$-8u7S8+BsfF/ g 4Q\wHmMd0(jIn61N(0.M0L^>. Biceps Tendon Injuries: Causes, Symptoms & Treatments - Cleveland Clinic 43 Tenotomy is the . Other more invasive treatments for persistent biceps tendonitis may include cortisone injections, platelet rich plasma injections, or surgery. In addition to the diagnostic criteria, increased color flow signals were recognized around the swollen biceps tendon as essential to a biceps tendinopathy diagnosis. Gaines MD. Phase II (1 week through 5 weeks post-op): Brace locked at 90 when not working on therapy exercises. The team of compassionate, highly renowned orthopedic surgeons and specialists at Hamilton Orthopedics, Spine & Sports Medicine are dedicated to providing patients with the most advanced orthopedic care in sports medicine, reconstructive surgery, total joint replacements and revisions, treatment of spinal cord injuries and diseases, on-site x-ray and casting, on-site physical therapy and rehabilitation, and arthroscopic rotator cuff repair. This state of the art facility offers the latest in orthopedic, plastics, pain management, urology and podiatry technique set by high qualified surgeons. A tendon is a band of connective tissue that attaches muscles to the bones. ruptures tend to occur in the dominant elbow (86%) of men (93%) in their 40s. Apply ice packs for 10 to 15 minutes every few hours to reduce inflammation and pain. Rehabilitation of a Surgically Repaired Rupture of the Distal Biceps Tendon in an Active Middle Aged Male: a case report. b__67W{.z}[vCK' IhVGyq? Its a sign of overuse and your body is telling you that it needs a rest. 199 0 obj <>stream ~F*.`(Eflws*PVLlq[na@3Z1>,w_y^yY1vKtWp$6&]&Y7,OZ8{u*^.o^+S SPFepov=$`9~9gOgjSHPxc!WV 'h*$=DVtaS+inqS&Dm{ Sg&nUQha9yq6R'x zFcqk'h' Q[!s.||~Fp-GHGaU4n]y Keep your arm straight. Proximal bicep tendonitis: This is when there is inflammation. ~;.Js71$!wB3154FGAu% Bicep Tendon Tear at the Elbow Joint - Verywell Health 172 0 obj <> endobj PRP for Biceps Tendonitis / Tendinosis - PRP Treatments This is seen particularly with deadlifts, pullups, and rowing. These are done to determine your functional baseline and to guide treatment for your shoulder. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Required fields are marked *. Some research has shown that iontophoresis can be effective for tendon problems, while other studies do not support its use as an anti-inflammatory treatment. Functional progression to athletic activity. Characteristics of proximal biceps tendinitis include the following: In addition, a thorough history includes a detailed account of the patients occupational history and current status of employment, hand dominance, history of injury/trauma to the shoulder(s) and/or neck, and any relevant surgical history. Most e-stim treatments, like transcutaneus electic neuromuscular stimilation (TENS) or neuromuscular electrical stimulation (NMES), last for about 10 to 20 minutes. 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 How to Treat Biceps Tendinitis Since the biceps tendon works to stabilize the front of your shoulder, it may become overworked if you have shoulder instability or rotator cuff tear. Clinical Physio. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Anecdotally, some people report improved symptoms and function with the tape, but it has not (yet) undergone vigorous scientific scrutiny. Physiother Theory Pract. It starts as two separate tendons that attach to the shoulder blade, just above the socket of your shoulder. These join into a single tendon that crosses the elbow and attaches to the radius, a bone in your forearm. Available from: Park SS, Loebenberg ML, Rokito AS, Zuckerman JD. If further information regarding the various biceps tenodesis surgical techniques the You may also do this next to a wall and rest your fingers on the wall. The most common surgery for bursitis is a bursectomy, which removes the inflamed bursa to help relieve pain and promote healing. The biceps tendon, the tendon associated with the biceps muscle, is made up of 2 parts: the long head and the short head. 9. Biceps pulley: normal anatomy and associated lesions at MR arthrography. Tendinopathy of the biceps can be painless early on. Surgical procedures are performed in the ultra-modern surgical suites at Community Memorial Hospital in Hamilton. Add Eccentrics: Eccentric exercise actually lengthens your muscles and decreases the risk of tendinitis. Use of Blood Flow Restriction (BFR) Therapy in Post-operative <> This will help reduce the pain and swelling associated with the injury. Appointments: Monday - Friday 7:00am - 4:30pm, Business Office: Monday - Friday 8:00am - 4:30pm, Physical Therapy: Monday - Friday 7:00am - 5:00pm. Most cases can be treated successfully in about four to six weeks. Baechle. The biceps brachii also helps to move and stabilize the shoulder, although to a lesser degree. Your PT will also ask about your medical history and may review any medication that you are taking. The biceps muscle has two tendons at the shoulder. Long head of the biceps pathology combined with rotator cuff tears. Your physical therapist may also have you perform a home exercise program that you do independently. Shoulder ROM exercises are encouraged. The LHB tendon undergoes degenerative changes, and associated scarring, fibrosis, and adhesions eventually compromise LHB tendon mobility.
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