Updated: 6/3/2021

Biceps Tendonitis

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
3
0
0
0%
0%
Evidence
24
0
0
0%
0%
Videos / Pods
11
Topic
Images
https://upload.orthobullets.com/topic/3045/images/8-1-2012 8-08-59 pm.jpg
https://upload.orthobullets.com/topic/3045/images/popeye.jpg
https://upload.orthobullets.com/topic/3045/images/8-1-2012 8-04-03 pm.jpg
  • summary
    • Biceps tendonitis is a well recognized source of anterior shoulder pain that may be associated with subscapularis tears and subacromial impingement.
    • Diagnosis can be suspected clinically with anterior shoulder pain made worse with provocative tests and confirmed with MRI studies to evaluate for concurrent pathology.
    • Treatment involves an initial trial of NSAIDs, activity modification and physical therapy. Arthorscopic versus open biceps tenodesis/tenotomy is indicated for recurrent symptoms.
  • Etiology
    • Pathoanatomy
      • more consistent with "tendinosis" than true inflammation
    • Often associated with other primary shoulder pathology
      • subacromial impingement
      • stenosis of bicipital groove
      • rotator cuff tears
        • especially subscapularis pathology
  • 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
  • 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
        • post-op rehab: tenodesis
          • avoid active forearm supination with the elbow at 90° of flexion
        • outcomes
          • tenotomy is associated with increased rate of cosmetic deformity ("Popeye deformity")
          • tenodesis may be associated with "groove pain"
          • no difference in strength, functional outcomes, or range of motion between two techniques
Flashcards (0)
Cards
1 of 0
Questions (3)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(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?

QID: 1135
1

Arm cramping

63%

(779/1228)

2

Elbow flexion weakness

26%

(314/1228)

3

Elbow stiffness

2%

(25/1228)

4

Shoulder weakness

4%

(55/1228)

5

Shoulder stiffness

4%

(48/1228)

L 3 D

Select Answer to see Preferred Response

Evidence (24)
VIDEOS & PODCASTS (12)
EXPERT COMMENTS (13)
Private Note