Biceps tendinitis: Difference between revisions
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==Background== | ==Background== | ||
[[File:1120 Muscles that Move the Forearm Humerus Flex Sin.png|thumb|Biceps tendon anatomy.]] | |||
*Results from progressive impingement or isolated tendon injury | *Results from progressive impingement or isolated tendon injury | ||
| Line 7: | Line 8: | ||
**May occur at rest and be worse at night | **May occur at rest and be worse at night | ||
== | ==Evaluation== | ||
*Palpation of tendon | *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 | **Flex patient's elbow to 90⁰ | ||
**Palpate bicipital groove as | **Palpate bicipital groove as patient patient attempts forearm supination against resistance | ||
**Pain/instability at prox bicipital groove indicates tendinitis or tendon subluxation | **Pain/instability at prox bicipital groove indicates tendinitis or tendon subluxation | ||
*Speed's test | |||
**Shoulder raised 60⁰ 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 DDX}} | |||
==Management== | |||
*Analgesia | |||
**[[NSAIDs]] | |||
*Relative rest | |||
*Ice 10-15min TID | |||
*Early mobilization with stretching exercises | |||
==Disposition== | ==Disposition== | ||
*Follow-up | *Follow-up with primary care provider within 1wk | ||
==See Also== | ==See Also== | ||
*[[ | *[[Shoulder diagnoses]] | ||
*[[ | *[[Biceps tendon rupture]] | ||
==References== | |||
<references/> | |||
[[Category: | [[Category:Orthopedics]] | ||
[[Category:Sports Medicine]] | |||
Revision as of 14:42, 8 June 2019
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 90⁰
- 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 60⁰ 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.