Biceps Tendinopathy Clinical Presentation

Updated: Feb 26, 2021
  • Author: Peter G Gonzalez, MD; Chief Editor: Robert H Meier, III, MD  more...
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Presentation

History

The diagnosis of biceps tendinopathy is primarily clinical. [4, 5] Patient history suggests the diagnosis. Characteristics of the condition are as follows:

  • Pain is reported in the region of the anterior shoulder located over the bicipital groove, occasionally radiating down to the elbow.

  • The pain is aggravated by activities that require shoulder flexion, forearm supination, and/or elbow flexion.

  • Pain is usually exacerbated by the initiation of activity.

  • Some patients describe fatigue with shoulder movements.

  • The symptoms are alleviated by rest, ice, massage, stretching, and sometimes heat.

  • Night pain is not uncommon.

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Physical

Physical examination for biceps tendinopathy includes the following:

  • Inspection - Muscle bulk of the shoulder girdle, anatomical abnormalities, posture

  • Palpation - For tenderness over the biceps tendon in the bicipital groove; compare side to side (because there is often tenderness in asymptomatic patients)

  • Range of motion (ROM) - Passive and active ROM of the shoulder in forward flexion, extension, abduction, adduction, internal and external rotation

  • Neurologic testing - Muscle strength, sensation, and deep tendon reflexes; strength testing possibly limited by pain

  • Special biceps tests

    • Speed test 1 (see image below) - With the forearm in the supinated position and the elbow fully extended, the patient attempts to flex the arm (forward flexion at the shoulder) against the resistance provided by the examiner. Tenderness in the bicipital groove is considered a positive test result and is indicative of bicipital tendinitis.

      Speed test. Speed test.
    • Speed test 2 - This test is a variation on Speed test 1. Test 2 may be performed by having the patient forward-flex the arm to 90º while the examiner tries to move the patient's arm into extension against resistance provided by the patient. A positive test result is indicated by discomfort or pain in the bicipital groove.

    • Yergason test (see image below) - The patient's elbow is flexed to 90º and is stabilized against the thoracic cage, with the forearm pronated; the examiner resists supination while the patient also laterally rotates the arm against resistance. The test is considered positive if the patient experiences discomfort or pain in the bicipital groove or if the tendon pops out of the groove.

      Yergason test. Yergason test.
    • Gilchrist test - The patient lifts a 5-pound weight overhead with an externally rotated arm and slowly lowers it to the lateral horizontal position. Discomfort or pain in the bicipital groove is considered a positive test result.

    • Lippman test - With the patient's arm flexed to 90º, the examiner palpates the biceps tendon 3 inches (7.6 cm) below the glenohumeral joint and moves the biceps tendon from side to side. Pain and a palpable displacement of the tendon from its groove indicate tenosynovitis with instability of the biceps tendon.

  • Other tests - Tests for associated rotator cuff, labral, and acromioclavicular joint pathology are as follows:

    • Impingement tests include the Hawkins-Kennedy test and the Neer test.

    • Acromioclavicular joint tests include the cross-body adduction test.

    • Labral tests include the O'Brien test, the anterior slide test, and the Clunk test.

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Causes

Biceps tendinopathy can result from the following causes:

  • Poor lifting techniques

  • Chronic, repetitive upper extremity activities (shoulder/elbow flexion)

  • Impingement syndrome

  • Biceps subluxation

  • Shoulder girdle muscle imbalances

  • Poor posture

  • Overload (usually eccentrically)

  • Lack of flexibility/capsular tightness

  • Direct trauma

  • Multidirectional shoulder instability

  • Calcifications of the tendon

  • Osteoarthritis and spurring

  • Anatomical abnormalities (eg, variations of the bicipital groove, fractures, first rib subluxations)

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