Biceps tendinitis

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
• 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
  • Anterior shoulder dislocation
  • Posterior shoulder dislocation
  • Inferior 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
  • Rucksack paralysis
• Axillary artery thrombosis
• Thoracic outlet syndrome
• Subclavian steal syndrome
• Pancoast tumor
• Myocardial infarction
• Pneumonia
• Pulmonary embolism

Management

• Analgesia
  • NSAIDs
• Relative rest
• Ice 10-15min TID
• Early mobilization with stretching exercises

Disposition

• Follow-up with primary care provider within 1wk

See Also

• Shoulder diagnoses