Biceps Tendinopathy Flashcards
What is meant by tendinopathy
variety of pathological changes that occur in tendons, typically due to overuse
what does tendinopathy result in
painful, swollen, and structurally weaker tendon that is at risk of rupture
In which people is biceps tendinopathy common in
Young individuals
Active - due to sport
Older people - degenerative tendinopathy
What are the clinical features of a patient with biceps tendinopathy
Pain - worse on stressing the tendon - Better with ice and rest
Weakness on flexion and supination
Stiffness
Examinations: tenderness over the tendon, loss of muscle bulk to to disuse atrophy
Which specific tests can be performed for biceps tendinopathy
Speed test - proximal biceps tendon
Yergasons test - distal biceps tendon
What is the speed test
Pt stands with elbows extended and forearm supination, then forward flex shoulders
against resistance
what is yergasons test
Pt stands with elbows fled at 90 degrees, forearm pronation. Active supination is then performed against resistance
what are the differential diagnoses of biceps tendinopathy
Inflammatory arthropathy
Radiculopathy
OA
Rotator cuff disease
How is biceps tendinopathy diagnosed
Largely clinical diagnosis
Blood tests - FBBC, CRP
Plain radiographs - first line often to exclude other things
USS
MRI
What is the management of biceps tendinopathy
Conservative using analgesia - NSAIDS
Ice therapy
Physiotherapy
USS guided steroid injections in cases that are unresponsive to conservative treatment
Surgical:
- Arthroscopic tenodesis (tendon is severed and reattached) or tenotomy (division of the tendon) for decompression
What are the complications
Most recover with no complications but a small number may get chronic pain
Higher risk of biceps tendon rupture
Is biceps tendon rupture common or uncommon
Uncommon
What are the classifications of biceps tendon rupture
Complete - through entire tendon
Partial - tendon rupture is partly intact
What is the MOA of biceps tendon rupture
sudden forced extension of a flexed elbow.
What are the risk factors for biceps tendon rupture
biceps tendinopathy
Steroid use
Smoking
CKD
Fluoroquinolones abx
What are the clinical features of biceps tendon rupture
Sudden onset pain and weakness
Feeling of a pop
Marked swelling and bruising in antecubital fossa
Reverse popeye sign
what test can be done to identify a distal tendon rupture
Hook test
What is the hook test
90 degree flexion of elbow with supination
examiner attempts to ‘hook’ their index finger underneath the lateral edge of the biceps tendon
What are the investigations of biceps tendon rupture
Diagnosed clinically but confirmed using USS
If USS inconclusive then MRI
What is the conservative management of biceps tendon rupture
Conservative - analgesia and physiotherapy
What is the surgical management of biceps tendon rupture
Anterior single incision
Dual incision technique
what is the anterior single incision
Involves single incision in the antecubital fossa
What is the dual incision therapy
dual incision technique involves a smaller anterior incision in the antecubital fossa and a posterolateral elbow incision (between the ECU and EDC).
When should surgery occur if that is the option to be considered
Within a few weeks of the rupture as the tendon with retract and scar
what are the main complications of biceps tendon rupture surgery
Injury to the lateral ante brachial cutaneous nerve
posterior interosseous nerve, or radial nerve (rare).
