Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Jun 7 2023

Biceps Tendonitis

Images
https://upload.orthobullets.com/topic/3045/images/8-1-2012 8-08-59 pm.jpg
https://upload.orthobullets.com/topic/3045/images/popeye.jpg
https://upload.orthobullets.com/topic/3045/images/8-1-2012 8-04-03 pm.jpg
  • summary
    • Biceps tendonitis is a well recognized source of anterior shoulder pain that may be associated with subscapularis tears and subacromial impingement.
    • Diagnosis can be suspected clinically with anterior shoulder pain made worse with provocative tests and confirmed with MRI studies to evaluate for concurrent pathology.
    • Treatment involves an initial trial of NSAIDs, activity modification and physical therapy. Arthorscopic versus open biceps tenodesis/tenotomy is indicated for recurrent symptoms.
  • Etiology
    • Pathoanatomy
      • more consistent with "tendinosis" than true inflammation
    • Often associated with other primary shoulder pathology
      • subacromial impingement
      • stenosis of bicipital groove
      • rotator cuff tears
        • especially subscapularis pathology
  • 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
  • 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 is associated with increased rate of cosmetic deformity ("Popeye deformity")
          • tenodesis may be associated with "groove pain"
          • no difference in strength, functional outcomes, or range of motion between two techniques
Card
1 of 0
Question
1 of 3
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options