Biceps Tendonitis - Shoulder & Elbow

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
- pain
  - anterior shoulder pain
  - may have pain radiating down the in the region of the biceps
  - symptoms may be simillar in nature and location to rotator cuff or subacromial impingement 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