Bicipital Tendinitis

Bicipital Tendinitis
Relevant anatomy
• The biceps tendon is one of the few tendons in the body to span
two joints: the glenohumeral complex and the elbow.
• Proximally, the biceps has two heads, one of which originates from
the coracoid process and the other that begins its course from
supraglenoid tubercle and superior labrum.
• Distally, the long and short heads of the biceps converge at the
midshaft of the humerus then insert on the anterior aspect of
radial tuberosity.
• Functionally , the biceps acts as
a strong forearm supinator and a
weak elbow flexor. However , it
is more active in flexion of the
supinated forearm than in flexion
of pronated forearm.
• Unlike many other tendons of the body, the biceps tendon differs
because its line of traction does not match the line of pull of the
adjoining musculature.
• This distinction occurs because the LHB tendon uses the head of
the humerus as a pulley when applying tensional force.
• In order to prevent excessive compression at this site, an innate

protective measure is put in place – a synovial sheath
• A synovial sheath, arising
from the synovium of the
GH joint, surrounds the
tendon to improve
tolerance to the external
stress and reduce
frictional forces imparted
on the soft tissue.
BICIPITAL TENDINITIS
• Bicipital tendinitis is inflammation of the tendon around the long head of

biceps muscle.
• Biceps inflammation and degeneration is most likely to occur with abrasive

motion as the long head of biceps tendon runs through the bicipital groove;
it is made worse with overhead and repetitive shoulder rotation activities.
• Histologic analysis has indicated that the sheath is where actual

inflammatory changes usually take place.
• The following biomechanical causes for biceps tendinitis:
• coracoacromial ligament thickening,
• impingement beneath the coracoacromial arch by a bone spur,
• acromial apophysis infusion.
• These pathologies can lead to biceps tendinitis because of repeated trauma

by overuse and improper biomechanical circumstances.
• The inflammation process can initially lead to biceps tendon
hyperemia and subsequent swelling of the tendon sheath because
of interstitial tissue osmolarity that is changed by the release of
chemokine.
• In the end stage of chronic inflammation, scarring and adhesion of

the biceps tendon in the bicipital groove can occur.
• These symptoms can be obstacles to activities of daily living, and

correct diagnosis and early treatment of biceps tendinopathy are
vital.
Epidemiology
• The incidence of biceps tendon injury in sport and different occupations is

unknown.
• Bicipital tendinopathy occurs in a variety of sports including weightlifting,
tennis, wheelchair athletics (and general wheelchair use), cricket, baseball,
and other sports where overhead activity is involved.
• Degenerative tendinosis and biceps tendon rupture are usually seen in older
patients.
• Isolated tendinopathy often presents in young or middle-aged patients but
the exact incidence is unknown.
Clinical presentation
• Patients will typically report an insidious onset of discomfort

around the region of the involved tendon.
• Patients with biceps tendinopathy/tendinitis often complain of a

deep, throbbing pain in the anterior shoulder that is intensified
when lifting.
• The pain is usually localized to the bicipital groove and might

radiate toward the insertion of the deltoid muscle.
• Patients are likely to present with a chief complaint of
anteromedial shoulder pain.
• Pain from biceps tendinopathy/tendinitis usually worsens at night,

especially if the patient sleeps on the affected shoulder.
• Pain may be aggravated by overhead reaching, pulling and lifting

activities.
• Pain with palpation over the bicipital groove is another common
physical exam finding for patients with biceps tendinopathy.
• Active elbow flexion may also provoke pain.

Differential Diagnosis
• Acromioclavicular joint pathology

• Adhesive capsulitis
• Cervical spine pathology
• Glenohumeral arthritis
• Glenohumeral instability
• Sub-acromial Impingement syndrome
• Rotator cuff tears
• Superior labrum anterior-posterior lesions (SLAP)
Diagnostic Procedure
• History
• Screening of cervical spine
• Active and passive ROM of cervical, shoulder and elbow
• Observation and palpation of involved structures
• Resistive testing
• Special tests
• Investigation
• Yergason test: Yergason test requires the patient to place the arm
at his or her side with the elbow flexed at 90 degrees, and
supinate against resistance. The test is considered positive if pain
is referred to the bicipital groove.
• Speed test: the patient tries to flex the shoulder against

resistance with the elbow extended and the forearm supinated. A
positive test is pain radiating to the bicipital groove..
Investigation
• This is a clinical diagnosis and investigation is not routinely required.

• Ultrasound is the examination of choice. Soft tissue ultrasound may
help to improve localisation prior to local steroid injection
• Plain X-ray may be used when there is a suspicion of neoplasia. The
demonstration of spurs, calcification or changes of osteoarthritis is
unlikely to help management.
• MRI scan can demonstrate the whole course of the biceps tendon
(including the intra-articular tendon and related intraarticular
• pathology) However, it is not appropriate or cost-effective for routine
use. It is indicated after unsuccessful rehabilitation or where there is
suspected rotator cuff or labral tear injury.
Management
• Patients should apply ice to the affected area for 10-15 minutes, 2-3
times per day for the first 48 hours.
• Rest from lifting, stretching and overhead use of the affected arm.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are

used for 3-4 weeks to treat inflammation and pain.
• Physical therapy intervention should include restoring a pain free range

of motion, as well as ensuring proper scapulothoracic rhythm.
• Other modalities of treatment which may be employed by physiotherapists,
including ultrasound, transcutaneous electrical nerve stimulation and
gentle stretching exercises.
• Pain free range can be achieved with such activities as PROM, Active-
Assisted Range of Motion (AAROM), and mobilization.
• Painful activities such as abduction and overhead activities should be

avoided in the early stages of recovery as it can exacerbate symptoms.
• Once a pain free range of motion is achieve, a strengthening
program should begin with emphasis on the scapular stabilizers,
rotator cuff and biceps tendon.
• For more chronic presentations, corticosteroid injections along the

tendon sheath may be indicated.
• Surgical management of biceps tendinitis includes removing the

long head of the biceps tendon via arthroscopic tenodesis.

Bicipital Tendinitis

Uploaded by

Copyright:

Available Formats

Bicipital Tendinitis

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Bicipital Tendinitis

Uploaded by

Copyright:

Available Formats

Bicipital Tendinitis

• In order to prevent excessive compression at this site, an innate

• Bicipital tendinitis is inflammation of the tendon around the long head of

• Biceps inflammation and degeneration is most likely to occur with abrasive

• Histologic analysis has indicated that the sheath is where actual

• These pathologies can lead to biceps tendinitis because of repeated trauma

• In the end stage of chronic inflammation, scarring and adhesion of

• These symptoms can be obstacles to activities of daily living, and

• The incidence of biceps tendon injury in sport and different occupations is

• Patients will typically report an insidious onset of discomfort

• Patients with biceps tendinopathy/tendinitis often complain of a

• The pain is usually localized to the bicipital groove and might

• Pain from biceps tendinopathy/tendinitis usually worsens at night,

• Pain may be aggravated by overhead reaching, pulling and lifting

• Active elbow flexion may also provoke pain.

• Acromioclavicular joint pathology

• Speed test: the patient tries to flex the shoulder against

• This is a clinical diagnosis and investigation is not routinely required.

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are

• Physical therapy intervention should include restoring a pain free range

• Painful activities such as abduction and overhead activities should be

• For more chronic presentations, corticosteroid injections along the

• Surgical management of biceps tendinitis includes removing the

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.