Bicipital Tendonitis Clinical Presentation

  • Author: Britt A Durham, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Feb 8, 2012
 

History

  • Patients typically complain of achy anterior shoulder pain, which is exacerbated by lifting or elevated pushing or pulling. A typical complaint is pain with overhead activity or with lifting heavy objects.
  • Pain may be localized in a vertical line along the anterior humerus, which worsens with movement. Often, however, the location of the pain is vague, and symptoms may improve with rest.
  • Most patients with bicipital tendinitis have not sustained an acute traumatic injury. However, partial traumatic biceps tendon ruptures have been described and may occur in combination with underlying tendinitis. Individuals with rupture of the long head of the biceps tendon may report a sudden and painful popping sensation. The retracted muscle belly bulges over the anterior upper arm, which is commonly described as the "Popeye" deformity. In patients without acute traumatic injuries, the biceps tendon rupture is usually preceded by a history of shoulder pain that quickly resolves after a painful audible snap occurs.
  • Occasionally, shoulder instability and subluxation can be associated with biceps degeneration from chronic tendinitis, resulting in a palpable snap in a painful arc of motion that is seen in throwing athletes. Superior labral tears (superior labrum anterior and posterior [SLAP] lesions) may have similar findings, but these injuries are more prone to locking or catching symptoms.[12]
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Physical

  • Local tenderness is usually present over the bicipital groove, which is typically located 3 inches below the anterior acromion. The tenderness may be localized best with the arm in 10 º of external rotation.
  • Flexion of the elbow against resistance aggravates the patient's pain.
  • Passive abduction of the arm in an arc maneuver may elicit pain that is typical of impingement syndrome; however, this finding may be negative in cases of isolated bicipital tendinitis.
  • Speed test: The patient complains of anterior shoulder pain with flexion of the shoulder against resistance, while the elbow is extended and the forearm is supinated.
  • Yergason test: The patient complains of pain and tenderness over the bicipital groove with forearm supination against resistance, with the elbow flexed and the shoulder in adduction. Popping of subluxation of the biceps tendon may be demonstrated with this maneuver.
  • The remainder of the examination should include evaluation and documentation of active and passive range of motion (ROM) and joint stability in order to assess the rotator cuff and glenoid labrum. A complete evaluation includes a complete neurovascular assessment.
  • Bicipital tendinitis with labral tears or rotator cuff tears may not improve if all the conditions are not treated.
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Causes

  • The long head of the biceps tendon passes down the bicipital groove in a fibrous sheath between the subscapularis and supraspinatus tendons. This relationship causes the biceps tendon to undergo degenerative and attritional changes that are associated with rotator cuff disease because the biceps tendon shares the associated inflammatory process within the suprahumeral joint.[13]
  • Full humeral head abduction places the attachment area of the rotator cuff and biceps tendon under the acromion. External rotation of the humerus at or above the horizontal level compresses these suprahumeral structures into the anterior acromion. Repeated irritation leads to inflammation, edema, microscopic tearing, and degenerative changes.
  • In younger athletes, relative instability due to hyperlaxity may cause similar inflammatory changes on the biceps tendon due to excessive motion of the humeral head.
  • Labral tears may disrupt the biceps anchor, resulting in dysfunction and causing pain.
  • The transverse humeral ligament holds the biceps tendon long head within the bicipital groove. Injuries and disruption of the ligament can lead to subluxation and medial dislocation of the biceps tendon. Local edema and calcifications can physically displace the biceps tendon from the bicipital groove, resulting in subluxation. An osteochondroma in the bicipital groove has been reported as a cause of bicipital tendinitis in a baseball player by physical displacement and subluxation.[14]
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Contributor Information and Disclosures
Author

Britt A Durham, MD  Director of Risk Management, Department of Emergency Medicine, Martin Luther King Medical and Trauma Center, King-Drew Medical Center; Assistant Professor of Emergency Medicine, Drew College of Medicine; Assistant Clinical Professor of Emergency Medicine, UCLA School of Medicine; Partner and Chief Financial Officer, Durcress Medical Group, California Medical Board District Medical Consultant, Lakewood Atheletic Sports Medicine Team Physician

Britt A Durham, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Richard Chambers, MD  Chief of Orthopedic, Diabetes and Amputee Service, Clinical Associate Professor, Department of Orthopedic Surgery, Rancho Los Amigos Medical Center, University of Southern California

Richard Chambers, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Diabetes Association, American Orthopaedic Foot and Ankle Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

David T Bernhardt, MD  Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics/Ortho and Rehab, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health

David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

References

  1. Ahrens PM, Boileau P. The long head of biceps and associated tendinopathy. J Bone Joint Surg Br. Aug 2007;89(8):1001-9. [Medline].

  2. Safran MR, McKaeg DB, Van Camp SP, eds. Biceps tendon injuries. Manual of Sports Medicine. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998:347-9.

  3. Nicholis JA, Hershman EB, eds. Bicipital tendinitis. The Upper Extremity in Sports Medicine. 2nd ed. St. Louis, Mo: Mosby; 1995:303-6.

  4. Rockwood CA Jr, Matsen FA II, eds. The Shoulder. Philadelphia, Pa: WB Saunders; 1990:810-21.

  5. Murtagh J. Bicipital tendinitis. Aust Fam Physician. Jun 1991;20(6):817. [Medline].

  6. Singaraju VM, Kang RW, Yanke AB, McNickle AG, Lewis PB, Wang VM, et al. Biceps tendinitis in chronic rotator cuff tears: a histologic perspective. J Shoulder Elbow Surg. Nov-Dec 2008;17(6):898-904. [Medline].

  7. Patton WC, McCluskey GM 3rd. Biceps tendinitis and subluxation. Clin Sports Med. Jul 2001;20(3):505-29. [Medline].

  8. Ellenbecker TS. Rehabilitation of shoulder and elbow injuries in tennis players. Clin Sports Med. Jan 1995;14(1):87-110. [Medline].

  9. Ouellette H, Labis J, Bredella M, et al. Spectrum of shoulder injuries in the baseball pitcher. Skeletal Radiol. Oct 3 2007;Epub ahead of print. [Medline].

  10. Park SS, Loebenberg ML, Rokito AS, Zuckerman JD. The shoulder in baseball pitching: biomechanics and related injuries -- part 1. Bull Hosp Jt Dis. 2002-2003;61(1-2):68-79. [Medline]. [Full Text].

  11. Hadala M, Barrios C. Sports injuries in an America's Cup yachting crew: A 4-year epidemiological study covering the 2007 challenge. J Sports Sci. May 2009;27(7):711-7. [Medline].

  12. Kim KC, Rhee KJ, Shin HD, Kim YM. A SLAP lesion associated with calcific tendinitis of the long head of the biceps brachii at its origin. Knee Surg Sports Traumatol Arthrosc. Dec 2007;15(12):1478-81. [Medline].

  13. Churgay CA. Diagnosis and treatment of biceps tendinitis and tendinosis. Am Fam Physician. Sep 1 2009;80(5):470-6. [Medline].

  14. Onga T, Yamamoto T, Akisue T, Marui T, Kurosaka M. Biceps tendinitis caused by an osteochondroma in the bicipital groove: a rare cause of shoulder pain in a baseball player. Clin Orthop Relat Res. Feb 2005;431:241-4. [Medline].

  15. Gaskin CM, Anderson MW, Choudhri A, Diduch DR. Focal partial tears of the long head of the biceps brachii tendon at the entrance to the bicipital groove: MR imaging findings, surgical correlation, and clinical significance. Skeletal Radiol. Oct 2009;38(10):959-65. [Medline].

  16. Buck FM, Grehn H, Hilbe M, et al. Degeneration of the long biceps tendon: comparison of MRI with gross anatomy and histology. AJR Am J Roentgenol. Nov 2009;193(5):1367-75. [Medline].

  17. Papatheodorou A, Ellinas P, Takis F, et al. US of the shoulder: rotator cuff and non-rotator cuff disorders. Radiographics. Jan-Feb 2006;26(1):e23. [Medline]. [Full Text].

  18. Lecoq B, Levasseur R, Fournier L, Schmutz G, Marcelli C. Atypical pattern of acute severe shoulder pain: contribution of sonography. Joint Bone Spine. Nov 2004;71(6):592-4. [Medline].

  19. Ardic F, Kahraman Y, Kacar M, et al. Shoulder impingement syndrome: relationships between clinical, functional, and radiologic findings. Am J Phys Med Rehabil. Jan 2006;85(1):53-60. [Medline].

  20. Rees JD, Wilson AM, Wolman RL. Current concepts in the management of tendon disorders. Rheumatology (Oxford). May 2006;45(5):508-21. [Medline]. [Full Text].

  21. Ellman H, Gartsman GM. Arthroscopic Shoulder Surgery and Related Procedures. Philadelphia, Pa: Lea & Febiger; 1993:243-4.

  22. Skedros JG, Hunt KJ, Pitts TC. Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians. BMC Musculoskelet Disord. Jul 6 2007;8:63. [Medline]. [Full Text].

  23. Mitra R, Nguyen A, Stevens KJ. Fluoroscopically guided supraglenoid tubercle steroid injections for the management of biceps tendonitis. Pain Pract. Jul-Aug 2011;11(4):392-6. [Medline].

  24. Sethi N, Wright R, Yamaguchi K. Disorders of the long head of the biceps tendon. J Shoulder Elbow Surg. Nov-Dec 1999;8(6):644-54. [Medline].

  25. Friedman DJ, Dunn JC, Higgins LD, Warner JJ. Proximal biceps tendon: injuries and management. Sports Med Arthrosc. Sep 2008;16(3):162-9. [Medline].

  26. Holtby R, Razmjou H. Accuracy of the Speed's and Yergason's tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Arthroscopy. Mar 2004;20(3):231-6. [Medline].

  27. Shah RR, Haghpanah S, Elovic EP, Flanagan SR, Behnegar A, Nguyen V, et al. MRI findings in the painful poststroke shoulder. Stroke. Jun 2008;39(6):1808-13. [Medline].

  28. van Tulder M, Malmivaara A, Koes B. Repetitive strain injury. Lancet. May 26 2007;369(9575):1815-22. [Medline].

 
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