Biceps Tendinopathy Workup

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

Laboratory Studies

No laboratory studies are necessary for the diagnosis of biceps tendinopathy.

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Imaging Studies

In patients with biceps tendinopathy, plain radiography may show calcifications in the biceps tendon or demonstrate associated degeneration in the glenohumeral or acromioclavicular joint. Fisk views help to evaluate the size of the biceps groove. Short, narrow margins of the groove may predispose the patient to biceps tendon subluxations. [24]

Ultrasonography can be used to assess the dynamic function of the biceps tendon. It is also useful for diagnosing biceps ruptures or instability. [6, 7, 8]

A study by Nho et al of patients with tendinopathy of the long head of the biceps demonstrated that, with regard to pathology detection, ultrasonography has a specificity of 98-100% and a sensitivity of 50-96%. Ultrasonography has proven to be a fast and cost-effective method of determining structural pathology of the long head of the biceps. [25]

Magnetic resonance imaging (MRI) is performed to rule out shoulder pathology (eg, rotator cuff tear, labral tears, biceps rupture). MRI may show signal changes in the biceps tendon that indicate pathology. [4]  However, a prospective study by Rol et al indicated that neither MRI nor computed tomography (CT) arthrography can effectively diagnose tendinopathy of the long head of the biceps preoperatively in patients with rotator cuff tear, with such imaging being able to adequately discern dislocation of the long head of the biceps from the bicipital groove but not subluxation and tendon degeneration. [26]

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Other Tests

Diagnostic local anesthetic infiltration of the region of the bicipital groove may help to clarify the source of nociception. If an alternate diagnosis is suggested, other tests can be performed.

Electromyography (EMG) or nerve conduction studies (NCSs) are performed to rule out mononeuropathy, brachial plexopathy, and cervical radiculopathy.

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