- Title
- The physical therapy management of individuals with long head of the biceps tendinopathy
- Creator
- McDevitt, Amy W.
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Shoulder pain related to the long head of the biceps tendon (LHBT) tendinopathy can be debilitating and difficult to treat. Patients often elect for more aggressive management including surgical intervention. Conservative management is recommended but there are limited established guidelines on the physical therapy (PT) management of the condition. Aims/Purpose: This thesis provides evidence-informed recommendations for PT based interventions while also contributing to the future development of RCTS and treatment guidelines focused on the management of LHBT tendinopathy. The overall aim of this thesis is to investigate PT interventions used to treat patients with LHBT tendinopathy. The thesis begins with a scoping review of interventions used to treat LHBT tendinopathy followed by a retrospective review of treatments utilized to treat suspected LHBT tendinopathy in a clinical setting. The results of the reviews identified a need for accurate diagnosis and informed a palpation study on the accuracy of clinicians’ ability to palpate the LHBT. Then to further support and supplement the reviews, the thesis includes a Delphi study, using expert consensus, to further identify recommended PT based interventions. The results of the scoping review, retrospective review, and Delphi study clarified the need to investigate multimodal approaches utilized to treat local LHBT pain and regional impairments associated with the condition. Therefore, a case series investigating the use of a multimodal approach to treating local LHBT pain was performed to collate and assess a combination of known interventions. Methods: By synthesizing the available information on management, the thesis will provide evidence informed interventions on the management of LHBT tendinopathy. A scoping review was performed to identify interventions used to treat LHBT tendinopathy. A retrospective chart review was conducted to understand interventions used by physical therapists to treat individuals with LHBT tendinopathy in a large hospital-based system. A need to better understand diagnosis drove an accuracy and reliability study to understand how well physical therapists can palpate the LHBT for purposes of examination and intervention. A Delphi study was performed to gain expert consensus on recommended interventions to treat individuals with LHBT tendinopathy. Information gathered from these studies supported a case series to determine how a multimodal approach to treatment impacts patient reported pain and disability. Results: The main findings of this thesis were: 1) therapeutic modalities and multimodal approaches, including manual therapy, exercise, and patient education, are recommended for LHBT tendinopathy by existing evidence; 2) PT was not highly utilized by patients with LHBT tendinopathy (in a hospital based system) prior to surgery; patients who did attend received a combination of active and passive treatments across several intervention themes; 3) physical therapists had poor inter-rater reliability and accuracy in palpating the LHBT in 2 positions; 4) experts identified 61 interventions across 7 themes as being effective for LHBT tendinopathy management; and 5) PT using the multimodal approach of dry needling, eccentric-concentric exercise, and stretching was effective in improving pain and disability in 10 patients with suspected LHBT tendinopathy. Conclusions: This thesis provides evidence informed recommendations for PT based interventions while also contributing to the future development of treatment guidelines for LHBT tendinopathy. The evidence presented in this thesis suggests that there are well-defined PT based interventions specifically designed to treat LHBT tendinopathy. While some research studies have examined interventions for managing initial tendon pain through therapeutic modalities and “physical therapy” has been generally recommended, there is a lack of detail on specific interventions, including the timing, dosage, and treatment progression. Thus, this thesis makes specific recommendations to inform next steps on understanding optimal interventions for the management of LHBT tendinopathy.
- Subject
- biceps tendinopathy; physiotherapy; rehabilitation; long head of the biceps tendon (LHBT); thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1482334
- Identifier
- uon:50917
- Rights
- Copyright 2023 Amy W. McDevitt
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 5 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 419 KB | Adobe Acrobat PDF | View Details Download |