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DPT 681 - MSK 1 > Biceps Pathologies > Flashcards

Biceps Pathologies Flashcards

1
Q

Shoulder Bicipital Pathologies:

  • Classifications = ?

4

Bicep Pathologies

A

Shoulder Bicipital Pathologies - Classifications:

(1) Bicipital Tendonitis

(2) Proximal Bicipital Tear

(3) Biceps Tenodesis

(3) Biceps Tenotomy

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2
Q

Shoulder Bicipital Pathologies - Characteristics:

  • Pain Pattern = ?
  • Risk Factors = ?
  • Observations = ?
  • Examinations = ?

Bicep Pathologies

A

Shoulder Bicipital Pathologies - Characteristics:

(a) Pain Pattern:

  • Anterior/Superior Shoulder Pain
  • Possible Painful Arc of motion 60-120d abduction.
  • Pain but minimal weakness.
  • Pain will be with shoulder flexion NOT abduction.
  • Pain worse with activity.

(b) Risk Factors:

  • Under 20 up to 40 Years Old
  • After 40 typically RTC involvement is co-occurring with impingement
  • Overhead activities
  • Increase in UE activities

(c) Observations:

  • Possible limited scapular upward mobility.
  • Superior/Anterior translation of humeral head.
  • Kyphotic Posture or limited thoracic mobility.

(d) Examinations:

  • (+) Biceps Test
  • Upper Cut Test
  • Yergason’s test
  • Speeds test
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3
Q

Shoulder Bicipital Pathologies - Manual Therapy:

  • Joint Mobiization = ?
  • STM/MFR = ?
  • PNF = ?

Bicep Pathologies

A

Shoulder Bicipital Pathologies - Manual Therapy

(a) Joint Mobiization:

  • Inferior/Posterior, Tractional GH Mobilizations.
  • AC and SC mobs
  • Cervical & Thoracic mobilization
  • Hyper or Painful = Grade I/II
  • Hypo = Grade III/IV/V

(b) STM/MFR:

  • Cross Frictional Pin and Stretch to Biceps, RTC, Pecs/Traps.

(c) PNF:

  • PNF diagonal ROM/stretching
  • Multiple angle isometrics with humeral head control/centering.
  • Contract relax stretching for improved mobility utilizing PNF.
  • Increase speed with PNF for quick reversals from muscle groups and multiplanar activities.
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4
Q

Shoulder Bicipital Pathologies - Therapeutic Exercise:

Bicep Pathologies

A

Shoulder Bicipital Pathologies - Therapeutic Exercise:

(a) Motor:

  • Scapular mobility for improved upward rotation
  • Eccentric shoulder/bicep activities.
  • RTC Strengthening endurance/reactivation.
  • Isometrics, Theraband isotonics, weights, single plane progressing to multiple plane endurance.
  • Scapular Muscular Strengthening
  • All Trapezius muscles, serratus, and rhomboids for improved scapular mobility and control.
  • Improved mobility of T-spine in all planes especially extension and rotation.

(b) Sensory:

  • Body blade
  • Rhythmical stabilization
  • Humeral head control to prevent anterior and superior migration.
  • Undermining/challenging postural stability as progression.
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5
Q

What do Bicep Pathologies in shoulder patients sound like in a patient interview?

Bicep Pathologies

A

Bicep Pathologies in shoulder patients sound like in a patient interview?

  • A mix of Labral Symptoms or RTC-like symptoms.
    • Biceps attaches to the top of the labrum so it can lead to labral dysfunction.
    • Bicep Tendonopathy may present similar to RTC pathology.
  • Bicep is shoulder flexor so dysfunction with overhead activities.
  • Pain in anterior/superior aspect of the shoulder.
  • Popping (superficial/anterior not the deep/clunking associated with labrum).
  • Lump in arm (older patient).
  • Pain with lifting overhead activities in younger adults.
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6
Q

Biceps Tendonitis / Biceps Rupture:

  • Prevalence = ?

Bicep Pathologies

A

Biceps Tendonitis / Biceps Rupture - Prevalence:

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7
Q

Biceps Tendonitis / Biceps Rupture:

  • Symptoms = ?

Bicep Pathologies

A

Biceps Tendonitis / Biceps Rupture - Symptoms:

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8
Q

Biceps Tendonitis / Biceps Rupture:

  • DSM/Signs = ?

Bicep Pathologies

A

Biceps Tendonitis / Biceps Rupture - Signs:

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9
Q

Biceps Tendonitis / Biceps Rupture:

  • TBC/Special Test = ?

Bicep Pathologies

A

Biceps Tendonitis / Biceps Rupture - Special Test:

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10
Q

Biceps Test = ?

Bicep Pathologies

A

Biceps Test:

  • Biceps Tendon Palpation
  • Movement: The clinician palpates
  • The origin of the long head of the biceps.
  • Assessment: A test is (+) if the palpation reproduces the client’s pain.
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11
Q

Upper Cut Test = ?

Bicep Pathologies

A

Upper Cut Test:

  • The patient assumes a standing position.
  • The patient is instructed to extend his/her elbow and fully supinate the forearm.
  • The examiner, standing in front of the patient, resists shoulder flexion from zero to 60 degrees.
  • Positive Test: If the patient localizes concordant pain to the bicipital groove.

Physiotutors Video

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12
Q

Yergason’s Test = ?

Bicep Pathologies

A

Yergason’s Test:

  • Primarily a test of the transverse humeral ligament for long head of biceps.
  • Pt elbow flexed to 90, forearm pronated.
  • Examiner resisted supination, lateral rotation, and in some cases elbow flexion.
  • Postive Test: Pain, popping of the biceps tendon with pain.

CR Video

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13
Q

Speed’s Test = ?

Bicep Pathologies

A

Speed’s Test (Biceps or Straight-Arm Test):

  • The patient assumes a standing position.
  • The patient is instructed to extend his/her elbow and fully supinate the forearm. The examiner, standing in front of the patient, resists shoulder flexion from zero to 60 degrees.
  • If the patient localizes concordant pain to the bicipital groove, the test is positive.

CR Video

SP = .61
SN = .32

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14
Q

Biceps Pathologies:

  • Tendinopathy / Tendonosis = ?

Bicep Pathologies

A

Biceps Pathologies:

Tendinopathy/Tendonosis:

  • Degenerative changes in the collagen matrix, hypercellularity, hypervascularity with an absence of inflammatory cells.
  • Realize the connection of the biceps to the superior labrum makes it a potential generator of labral dysfunction (SLAP).
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15
Q

Cluster for Biceps = ?

Bicep Pathologies

A

Cluster for Biceps:

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16
Q

Arthroscopic view of bicep pathology

Click to view

Bicep Pathologies

A
17
Q

Biceps Repairs:

  • Biceps tenotomy = ?
  • Biceps tenodesis = ?

Bicep Pathologies

A

Biceps Repairs:

(a) Biceps tenotomy:

  • If cosmesis isn’t an important factor the tendon can simply be released.

(b) Biceps tenodesis:

  • If the tendon is reattached (biceps tenodesis) then therapy needs to follow the surgeon protocol of 4-8 weeks of protection during the reattachment phase.
18
Q

Rehab for Proximal Biceps Dysfunction = ?

Bicep Pathologies

A

Rehab for Proximal Biceps Dysfunction:

  • PROM, AAROM during the early post-op period.
    • Progress into AROM and then strengthening with avoidance of higher loads until 6 months.
  • Scar tissue management manually or with instrument.
  • Bicipital tendinopathy will benefit from eccentric loading and biomechanically corrections of the GH joint and scapular rhythms.
  • Cross friction, ART, and soft tissue mobilization can assist in healing of the affected tissue.
19
Q

Manual Therapy for Bicipital pathologies = ?

Bicep Pathologies

A

Manual Therapy for Bicipital pathologies:

  • Cross friction to the biceps.
  • Rhythmic stabilization PNF activities for control of biceps tendon as well as it’s connection to the labrum.
  • Address scapular immobility’s with scapular mobilizations.
20
Q

Take Home message about Bicipital Pathologies

Flip and Read

Bicep Pathologies

A

Take Home message about Bicipital Pathologies:

(A) Three main types of bicipital pathologies:

  • Complete tears of proximal biceps which are fairly rair.
  • Long-term dysfunction / impingement / tendinosis of the biceps associated with co-occuring cuff and labral damage.
  • Acute bicipital tendonitis as an isolated pathology that will behave similar to acute bursitis only has associated clicking and popping of the biceps tendon.

(b) Treat bicipital pathologies in a similar manner to all other shoulder pathologies by treating the impairments with the only difference being an increase emphasis on shoulder flexion/eccentric shoulder flexion and a shift of the manual therapies to the anterior aspect of the shoulder.

DPT 681 - MSK 1 (17 decks)

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