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Updated: May 10 2025

Biceps Tendonitis

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  • 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
    • With persistent inflammation, the intra-articular portion of the biceps tendon can become hypertrophied, leading to incarceration within the joint during movement, especially elevation
  • 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"
            • suprapectoral versus subpectoral 
              • similar outcomes in residual pain, bicipital groove pain, Popeye deformity, range of motion, and patient-reported outcomes 
          • no difference in strength, functional outcomes, or range of motion between tenotomy and tenodesis
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Question
1 of 8
QID 219462 (Type "219462" in App Search)
A 79-year old femur sustains repeat falls two weeks after total knee arthroplasty was performed. Radiographs (Image A and B) demonstrate a distal femur periprosthetic fracture. In counseling her regarding her treatment options, what is one important outcome difference when comparing intramedullary nail fixation, open reduction internal fixation, and distal femoral replacement?
  • A
  • B

Open reduction internal fixation has a higher rate of complications

18%

146/815

Distal femoral replacement has better outcome scores

13%

107/815

Intramedullary nail fixation has a higher rate of malunion

40%

323/815

Distal femoral replacement has a higher rate of reoperation

15%

126/815

Distal femoral replacement has greater postoperative knee range of motion

13%

107/815

  • A
  • B

Select Answer to see Preferred Response

Shoulder & Elbow⎪Biceps Tendonitis
  • Shoulder & Elbow
  • - Biceps Tendonitis
9:44 min
1/31/2020
641 plays
5.0
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