Biceps Tendinopathy Flashcards
What is biceps tendinopathy?
Broad tearm to encompass a variety of pathological changes.
Results in painful, swollen and structurally weaker tendon that can cause rupture.
Can occur both in the proximal and distal bicep tendons.
Epidemiology
Common in younger individuals who are active (tennis, cricket)
Also common in older but due to degenerative tendinopathy.
Clinical features
Pain made worse by stressing the tendon and alleviated with rest and ice therapy
Weakness (flexion and supination) and stiffness
Examination findings
Tenderness over affected tendon
Can be disuse atrophy due to not using it
Special tests done in biceps tendinopathy
Speed test
Yergason’s test
Explain Speed’s test
Tests proximal biceps tendon
The patient stands with their elbows extended and forearms supinated.
They then forward flex their shoulders against the examiners resistance.
Explain Yergason’s test
Patient stands with their elbows flexed 90 degrees and forearm pronated.
They then actively supinate against the examiners resistance
(Pain = +ve)
Dx
Inflammatory arthropathy
Radiculopathy
OA
Rotator cuff disease
Biceps tendinopathy rarely occurs in isolation
Ix
Diagnosis is largely clinical further tests are usually only done if there is uncertainty
Bloods (FBC and CRP)
Plain film x-ray to exclude dx
USS and MRI is rarely done but can be considered.
Findings on USS and MRI
Can show thickened and inflamed tendons
Management of biceps tendinopathy
1st line - Conservative with analgesia (NSAIDs) + Ice therapy
Physio
2nd - USS-guided steroid injecitons if unresponsive
3rd - Surgical with arhtroscopic tenodesis or tenotomy in refractory cases.
What is arthroscopic tenodesis and tenotomy?
Arthroscopic tenodesis = Tendon is severed and reattached
Tenotomy = Cutting the tendon
Prognosis
Most recover well with no complications
Small proportions of cases can develop recurrent or chronic pain.
Chronic cases have a risk of biceps tendon rupture.
