biceps tendinopathy Flashcards
what is a tendinopathy?
a variety of pathological changes that occur in tendons, usually due to overuse
will result in a painful, swollen and structurally weaker tendon that is at risk of rupture
where can biceps tendinopathy occur?
can occur in both the proximal and distal biceps tendon
who can this happen to?
common in younger individuals who are active and in older individuals with more of a degenerative tendinopathy
what are the clinical features of biceps tendinopathy?
- pain, made worse with stress on tendon and alleviated through rest and ice therapy
- weakness
- stiffness
- tenderness
- potential loss of muscle bulk due to disuse atrophy
what tests can be done for a proximal biceps tendinopathy?
Speed test (proximal biceps tendon)
The patient stands with their elbows extended and their forearms supinated. They then forward flex their shoulders against the examiners resistance
what test can be done for a distal biceps tendinopathy?
Yergason’s test (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 are the differentials?
- radiculopathy
- osteoarthritis
- rotator cuff disease
- inflammatory arthropathy
what investigations are done into biceps tendinopathy?
usually clinically diagnosed
can do
- FBC and CRP
- plain film radiographs, most useful to exclude other differentials
- US to identify thickened tendons and MRI imaging to show thickened inflamed tendons
how is biceps tendiopathy managed?
treat conservatively
- analgesia (NSAIDs)
- ice therapy
- physiotherapy
- can use US guided steroid injections in unresponsive cases
rarely, surgery. Arthroscopic tendodesis or tenotomy for decompression are options to be discussed if indicated.
what is the risk of chronic biceps tendinoapthy cases?
biceps tendon rupture
how can a biceps tendon rupture be classified?
either complete (through entire tendon) or partial (remains partly intact) tears.
what movement usually causes a biceps tendon rupture?
These injuries typically occur following sudden forced extension of a flexed elbow
what are the risk factors for a biceps tendon rupture?
- previous episodes of biceps tendinopathy
- steroid use
- smoking
- CKD
- use of fluoroquinolone antibiotics
what are the clinical features of a biceps tendon rupture?
- sudden onset pain and weakness
- patient will report feeling a ‘pop’ during incident
- marked swelling and bruising in antecubital fossa
- as proximal muscle belly retracts due to loss of counter traction, bulge may become evident in arm ‘reverse popeye sign’
what is the hook test?
special test to identify a potential distal tendon rupture
The elbow is actively flexed to 90º and fully supinated, the examiner attempts to ‘hook’ their index finger underneath the lateral edge of the biceps tendon (which cannot be done in a ruptured biceps tendon)
