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 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 may be associated with arm cramping and cosmetic deformity ("Popeye deformity") tenodesis may be associated with "groove pain" no difference in strength between two techniques - both recover elbow and forearm strength post-op
QUESTIONS 1 of 3 1 2 3 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK 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? Review Topic QID: 1135 1 Arm cramping 63% (407/645) 2 Elbow flexion weakness 25% (161/645) 3 Elbow stiffness 2% (12/645) 4 Shoulder weakness 5% (34/645) 5 Shoulder stiffness 4% (29/645) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 1
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