Biceps tendinitis: Difference between revisions
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*Palpation of tendon within bicipital groove reproduces pain | *Palpation of tendon within bicipital groove reproduces pain | ||
*Forearm supination, especially against resistance, reproduces pain | *Forearm supination, especially against resistance, reproduces pain | ||
*Clinical exam tests below do not perform consistently, are only moderately specific, and do not change the post-test probability significantly<ref>Holtby R and Razmjou H. Accuracy of the Speed's and Yergason's tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Arthroscopy. 2004 Mar;20(3):231-6.</ref> | |||
*Yergason Test | *Yergason Test | ||
**Flex patient's elbow to 90' | **Flex patient's elbow to 90' | ||
Revision as of 17:20, 7 October 2016
Background
- Results from progressive impingement or isolated tendon injury
Clinical Features
- Pain
- Acute, intense, localized to anterior aspect of shoulder
- May occur at rest and be worse at night
Evaluation
- Palpation of tendon within bicipital groove reproduces pain
- Forearm supination, especially against resistance, reproduces pain
- Clinical exam tests below do not perform consistently, are only moderately specific, and do not change the post-test probability significantly[1]
- Yergason Test
- Flex patient's elbow to 90'
- Palpate bicipital groove as patient patient attempts forearm supination against resistance
- Pain/instability at prox bicipital groove indicates tendinitis or tendon subluxation
- Speed's test
- Shoulder raised 60 degrees in front flexion
- With forearm supinated and elbow fully extended
- Examiner presses down on forearm and patient resists pressure
- Pain/instability at bicipital groove where long head inserts indicates tendinitis or instability
Differential Diagnosis
Shoulder and Upper Arm Diagnoses
Traumatic/Acute:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Management
- Analgesia
- Relative rest
- Ice 10-15min TID
- Early mobilization with stretching exercises
Disposition
- Follow-up with primary care provider within 1wk
See Also
References
- ↑ Holtby R and Razmjou H. Accuracy of the Speed's and Yergason's tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Arthroscopy. 2004 Mar;20(3):231-6.