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
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