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
  • 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:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

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

  1. 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.