summary Biceps subluxation is a recognized cause of anterior shoulder pain usually associated with a subscapularis tear. Diagnosis can be suspected clinically with anterior shoulder pain made worse with provocative tests and confirmed with MRI studies to evaluate for concurrent subscapularis tear. Treatment involves an initial trial of NSAIDs, activity modification and physical therapy. Arthorscopic versus open biceps tenodesis/tenotomy with or without subscapularis repair is indicated for recurrent symptoms. Etiology Pathophysiology most commonly associated with subscapularis tears most common associated pathology disruption of the 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 decreased angle between the long head biceps to glenoid during arthroscopy has been associated with biceps tendon subluxation 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 4 1 2 3 4 Previous Next (SBQ16SM.1) A 55-year-old patient presents with right shoulder pain and weakness after a posterior shoulder dislocation that has not improved with physical therapy. Physical examination reveals significant pain with passive ROM and significant rotator cuff weakness. Figure A is the current MRI of the right shoulder. Which structure is most likely injured based on the current imaging findings? QID: 211117 FIGURES: A Type & Select Correct Answer 1 Anterior inferior glenohumeral ligament 28% (402/1458) 2 Coracohumeral ligament 22% (327/1458) 3 Superior labrum 10% (145/1458) 4 Infraspinatus tendon 18% (257/1458) 5 Posterior labrum 21% (313/1458) L 5 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept (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? QID: 4828 FIGURES: A B C D E Type & Select Correct Answer 1 Her clinical examination is most consistent with a SLAP tear, which should be repaired. 4% (166/4017) 2 Her biceps pathology is due to her partial tearing of her subscapularis 76% (3047/4017) 3 She has isolated degenerative biceps tendonosis and an injection may cure her symptoms 7% (286/4017) 4 She has end-stage rotator cuff arthropathy and should consider a reverse total shoulder arthroplasty 1% (59/4017) 5 Her subacromial impingement is causing her biceps tendon sheath to be inflamed 10% (410/4017) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
All Videos (4) Podcasts (1) Login to View Community Videos Login to View Community Videos 2018 Winter SKS Meeting: Shoulder, Knee, & Sports Medicine Video Spotlight: Arthroscopic Suprapectoral Biceps Tenodesis - Eric McCarty, MD (2.14, 2018 Winter SKS) Eric McCarty Shoulder & Elbow - Biceps Subluxation B 7/16/2018 386 views 5.0 (1) Login to View Community Videos Login to View Community Videos Arthroscopic Biceps Tenodesis - Dr. Mark Miller Mark Miller Shoulder & Elbow - Biceps Subluxation A 10/11/2012 941 views 4.9 (7) Login to View Community Videos Login to View Community Videos Open Subpectoral Biceps Tenodesis - Dr. Mark Miller Mark Miller Shoulder & Elbow - Biceps Subluxation C 10/11/2012 709 views 3.0 (2) Shoulder & Elbow | Biceps Subluxation Shoulder & Elbow - Biceps Subluxation Listen Now 9:48 min 3 weeks ago 26 plays 0.0 (0) See More See Less