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Proximal Biceps Tendonitis

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Topic updated on 01/07/14 7:49am
Introduction
  • Well recognized as a pain generator in the shoulder
  • Often associated with other primary shoulder pathology
    • subacromial impingement
    • stenosis of bicipital groove
    • rotator cuff tears
      • especially subscapularis pathology
  • Pathoanatomy
    • more consistent with "tendinosis" than true inflammation
Anatomy
  • Glenohumeral anatomy 
  • Bicep long head tendon 
    • originates off supraglenoid tubercle and superior labrum
    • stabilized within bicipital groove by transverse humeral ligament 
Presentation
  • Symptoms
    • anterior shoulder pain 
  • Physical exam 
    • tenderness with palpation over biceps groove 
      • worse with arm internally rotated 10 degrees
    • Speed test 
      • pain elicited in bicipital groove when patient attempts to forward elevate shoulder against examiner resistance while elbow extended and forearm supinated. 
      • may also be positive in patients with SLAP lesions.
    • Yergason's test 
      • pain elicited in biceps groove when patient attempts to actively supinate against examiner resistance with elbow flexed to 90-degrees and forearm pronated 
    • "popeye" deformity
      • indicates rupture
Imaging
  • Ultrasound
    • can show thickened tendon within bicipital groove
  • MRI 
    • can show thickening and tenosynovitis of proximal biceps tendon
      • increased T2 signal around biceps tendon 
Treatment
  • Nonoperative
    • NSAIDS, PT strengthening, and steroid injections
      • indications
        • first line of treatment
      • technique
        •  direct steroid injection in proximity, but not into tendon
  • Operative
    • arthroscopic tenodesis vs. tenotomy
      • indications 
        • surgical release reserved for refractory cases for bicep pathology seen during arthroscopy 
      • technique 
        • repair vs. release/tenodesis 
      • outcomes
        • tenodesis may decrease subjective arm cramping and improve cosmesis q

 

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Qbank (2 Questions)

TAG
(OBQ11.213) A patient presents to your office for evaluation of arm pain. Upon evaluation, a diagnosis of rupture of the long head of the biceps tendon is made. Which of the following photographs would best corroborate this diagnosis? Topic Review Topic
FIGURES: A   B   C   D   E  

1. A
2. B
3. C
4. D
5. E

PREFERRED RESPONSE ▶
TAG
(OBQ05.249) While recent studies have failed to demonstrate a significant clinical difference, proximal biceps tenodesis compared to tenotomy is felt to possibly result in a lower incidence of which of the following? Topic Review Topic

1. Arm cramping
2. Elbow flexion weakness
3. Elbow stiffness
4. Shoulder weakness
5. Shoulder stiffness

PREFERRED RESPONSE ▶



Videos

video
Video portrays Speed's test of shoulder for proximal biceps tendonitis.
8/2/2012
1499 views
2
video
Video portrays Yergason's test of the shoulder for proximal bicep pathology.
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video
Video shows arthroscopic proximal biceps tenodesis technique.
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4
video
Short video describing pathology of proximal biceps tendonitis and its treatment...
8/2/2012
86 views
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