|
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
Introduction
  • Well recognized as a pain generator in the shoulder
  • Often associated with other primary shoulder pathology
    • subacromial impingement
    • stenosis of bicipital groove
    • rotator cuff tears
      • especially subscapularis pathology
  • Pathoanatomy
    • more consistent with "tendinosis" than true inflammation
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
      • indicates rupture
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 may be associated with arm cramping and cosmetic deformity ("Popeye deformity")
        • tenodesis may be associated with "groove pain" q
        • no difference in strength between two techniques - both recover elbow and forearm strength post-op 
 

Please rate topic.

Average 3.9 of 30 Ratings

Questions (2)
Question locked
Sorry, this question is for
Virtual Curriculum Members Only
Click here to purchase

(OBQ05.249) While recent studies have failed to demonstrate a significant clinical difference, proximal biceps tenodesis compared to tenotomy is felt to possibly result in a lower incidence of which of the following? Review Topic

QID: 1135
1

Arm cramping

57%

(223/392)

2

Elbow flexion weakness

28%

(110/392)

3

Elbow stiffness

2%

(9/392)

4

Shoulder weakness

7%

(27/392)

5

Shoulder stiffness

6%

(22/392)

Select Answer to see Preferred Response

PREFERRED RESPONSE 1
EVIDENCE & REFERENCES (24)
VIDEOS (9)
GROUPS (1)
Topic COMMENTS (9)
Private Note