Biceps tendinopathy - TM Flashcards
What is biceps tendinopathy?
- Variety of pathological changes within tendon
- = painful, swollen, structurally weaker and increase risk of rupture
Where can biceps tendinopathy occur?
- Proximal or distal bicep
- In younger active people esp sports with repetitive flexion and older individuals with degenerative changes
Clinical features tendinopathy
- Pain
- Worsened with stressing the tendon
- Alleviated by rest and ice
- Weakness of flexion and supination
- Stiffness
- Tenderness over tendon
- Can get disuse atrophy if pain has made them stop using limb
Special tests for biceps tendinopathy
- Speed test - proximal biceps tendon
- Yergasons test - distal
Speed test
- Elbows extended
- Forearms supinated
- Forward flex shoulders against examiners resistance
Yergasons test
- Elbows flexed to 90 degrees
- Forearm pronated
- Actively supinate against resistance
Investigations biceps tendinopathy
- Clinical diagnosis largely
- Can do bloods, CRP and plain radiographs to exclude other diagnosis
- Specialist imaging eg USS and MRI can be used to show thickened (and inflamed for MRI) tendons
Management biceps tendinopathy
- Conservatively
- NSAIDs for analgesia
- Ice
- Physiotherapy
- USS guided steroid injections can be used if not responsive to initial therapy
Surgery for biceps tendinopathy
- RARE - for decompression
- Arthroscopic tenodesis (tendon severed and reattached) OR
- Tenotomy (division of tendon)
Complication of BT
- Rupture of biceps tendon
Biceps tendon rupture - how and what
- Can be complete or partial tear
- Often occur following sudeen forced extension of flexed elbow (distal)
RF biceps tendon rupture
- Previous biceps tendinopathy
- Steroid use
- Smoking
- CKD
- Fluoroquinolone abx eg Ciprofloxacin
Clinical features of rupture
- Sudden onset of pain and weakness - flexion at elbow remain due to brachialis and supinator
- Swelling and bruising
- Feeling of ‘pop’
- As proximal belly retracts, can get ‘reverse popeye sign’
Test for distal tendon rupture
Hook test
* Elbow flexed at 90 degrees
* Fully supinated
* Examiner attempts to hook index finger underneath lateral edge of biceps tendon - cannot be done if ruptured
Investigations for rupture
- Clinically
- Confirm via USS
- Also help surgeon localise distal end of biceps tendon which can retract proximally
- If USS inconclusive but suspect still - MRI
Management biceps rupture
- Flexion and supination can still occur but weakened - not all cases need surgical management
- BUT fatigueable and weak muscles = problem
- For lower demand pts - conservative with analgesia and physio
- Others - surgery
Surgical management biceps rupture
- Anterior single incision OR
- Dual incision technique
- Form bone tunnel in radius and reinsert ruptured tendon end
- Should occur within few weeks of injury otherwise tendon retracts and scars
Antecubital fossa incision or antecubital and posterolateral elbow
Complications surgery for biceps rupture
Injury to:
* Lateral antebrachial cutaenous nerve
* Posterior interosseous nerve
* Radial nerve (rare)
Proximal vs distal biceps rupture
- Proximal of long head more common (glenoid), shoulder pain, popeye sign
- Distal less common, reverse popeye sign
