Biceps Tendinopathy Flashcards
What is tendinopathy?
Tendinopathy is a broad term used to encompass a variety of pathological changes that occur in tendons, typically due to overuse. This results in a painful, swollen, and structurally weaker tendon that is at risk of rupture.
What is biceps tendinopathy?
Biceps tendinopathy can occur in both the proximal and distal bicep tendons.
Who is commonly affected by biceps tendinopathy?
It is common in younger individuals who are active (e.g. sports with repetitive flexion movements, such as tennis or cricket) and in older individuals with more of a degenerative tendinopathy.
What are the clinical features of biceps tendinopathy?
Patients will present with pain, made worse with stressing the tendon (and alleviated through rest and ice therapy). This can also be associated with weakness (flexion and supination) and stiffness.
On examination, patients will demonstrate tenderness over the affected tendon. If the patients has avoided using the limb due to pain, there may be a loss of muscle bulk due to disuse atrophy.
What are the special tests use to investigate biceps tendinopathy?
There are certain special tests that can be performed specifically for biceps tendinopathy known as Speed test and Yergason’s test.
Briefly describe Speed test
Tests proximal biceps tendon.
The patient stands with their elbows extended and their forearms supinated. They then forward flex their shoulders against the examiners resistance.
Briefly describe Yergason’s test
Tests distal biceps tendon.
The patients stands with their elbows flexed to 90 degrees and their forearm pronated. They actively supinate against the examiners resistance.
What investigations should be ordered for biceps tendinopathy?
The diagnosis of bicep tendinopathy is largely clinical, with further investigations reserved for cases where there is diagnostic uncertainty.
Blood tests (FBC and CRP) and plain film radiographs can be undertaken as first line investigations, often most useful to exclude other differentials.
Specialist imaging is rarely warranted, but ultrasound imaging can identify involved thickened tendons and MRI imaging can show thickened inflamed tendons.
Briefly describe the conservative management of biceps tendinopathy
Nearly all cases can be treated conservatively, with the use of analgesia (specifically NSAIDs, if tolerated) and ice therapy as first line. Physiotherapy also plays an important role.
When are steroid injections used to treat biceps tendinopathy?
Ultrasound-guided steroid injections can be useful in cases unresponsive to initial conservative management.
Briefly describe the surgical management of biceps tendinopathy
Rarely, surgical options are required in refractory cases. Arthroscopic tenodesis (tendon is severed and reattached) or tenotomy (division of the tendon) for decompression are options that may be discussed with the patient if indicated.
What are the complications of biceps tendinopathy?
Most cases will recover well with no complications. Small proportion of cases may develop recurrent or chronic pain at the affected site or some weakness.
Chronic cases are at an increased risk of having a biceps tendon rupture.
What differentials should be considered for biceps tendinopathy?
The main differential diagnoses to consider in a patient with suspected biceps tendinopathy include inflammatory arthropathy, radiculopathy, osteoarthritis, or rotator cuff disease (for proximal tendon involvement).
Biceps tendinopathy is rarely an isolated pathology and often the differentials may be co-existing, hence the need for thorough history and examination.
