Topic
Review Topic
0
0
Questions
3
0
0
Evidence
5
0
0
Videos
4
https://upload.orthobullets.com/topic/3046/images/4-26-2012 6-26-33 pm.jpg
https://upload.orthobullets.com/topic/3046/images/tenodesis.jpg
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 
 

Please rate topic.

Average 4.0 of 17 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
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

(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:
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
ARTICLES (9)
VIDEOS (4)
Topic COMMENTS (5)
Private Note