Introduction A recognized cause of shoulder symptoms usually associated with a subscalaris tear Pathophysiology most commonly associated with subscapularis tears most common associated pathology coracohumeral ligament tear disruption of the medial biceps sling Anatomy Biceps tendon anatomy originates off supraglenoid tubercle and superior labrum stabilized by the biceps sling which is comprised of fibers of the subscapularis supraspinatus coracohumeral superior glenohumeral ligaments Function acts as dynamic stabilizer involved in movement such as shoulder flexion, abduction Complete glenohumeral anatomy Presentation Symptoms anterior shoulder pain may have sensation of clicking Physical exam of shoulder strength due to the association with subscapularis tears, strength of the subscapularis muscle should be performed biceps provocation tests Yergason's test anterior shoulder pain with resisted forearm supination with the arm at the side and the elbow flexed to 90 degrees. Speed's test anterior shoulder pain with resisted shoulder flexion with the shoulder flexed at 90 degrees, elbow in full extension and the palm facing upwards" palpable click may be produced with arm abduction and external rotation occurs when tendon subluxes or dislocates out of groove Imaging Ultrasound can give dynamic test of bicep instability MRI can show increased T2 signal, and displacement out of the bicipital groove coincides with subscapularis tears Treatment Nonoperative NSAIDS, PT strengthening, and steroid injections indications initial management technique direct steroid injection in proximity, but not into tendon Operative arthroscopic vs open biceps tenotomy vs tenodesis indications reserved for refractory cases for bicep pathology technique performed with or without subscapularis repair can test instability intra-operatively
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 (OBQ13.193) A 62-year-old woman presents with chronic shoulder pain. On physical exam, she has anterior shoulder pain and her symptoms are reproduced with provocative testing of the biceps including supination against resistance and forward flexion of the shoulder against resistance. Internal and external rotation are painful, but her range of motion is intact. Shoulder radiograph and MRI images are shown in Figures A-E. Which of the following statements is true regarding the patient's condition? Review Topic QID: 4828 FIGURES: A B C D E 1 Her clinical examination is most consistent with a SLAP tear, which should be repaired. 4% (108/2806) 2 Her biceps pathology is due to her partial tearing of her subscapularis 76% (2123/2806) 3 She has isolated degenerative biceps tendonosis and an injection may cure her symptoms 7% (207/2806) 4 She has end-stage rotator cuff arthropathy and should consider a reverse total shoulder arthroplasty 1% (37/2806) 5 Her subacromial impingement is causing her biceps tendon sheath to be inflamed 10% (292/2806) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 2
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