Biceps Tendiopathy and Tendon Rupture Flashcards
True or False
Biceps tendon ruptures can occur at both proximal and distal locations
True
Biceps tendon injuries appear to occur more often among patients who do what?
engage in frequent pulling, lifting, reaching, or throwing for work or recreation
Rock climbers and weight lifters for example
Where does the long head of the biceps brachii originate?
at the superior glenoid tubercle, where it contributes to the formation of the glenoid labrum
Where does the short head of the biceps brachii originate?
at the coracoid process
It is believed that ____ biceps tendon injury is not due to a unique mechanism but rather results from general shoulder pathology, such as impingement or instability
proximal
What contributes to tendon injury within the bicipital groove, below the acromion, or at the labral attachment?
Dysfunction of the rotator cuff and scapular stabilizers
The frequency of biceps tendon tears ____ with age
increases
What is rupture of the proximal biceps tendon associated with?
RC tears
What does the acute mechanism of distal biceps tendon rupture often involve?
a sudden traumatic extension of a flexed elbow when the biceps muscle is fully contracted
Other than a RC tear, what are a few differential diagnoses for biceps tendinopathy?
- Glenohumeral arthritis
- AC pathology
- Pectoralis minor strain
- Referred cervical or brachial plexus pain
- Diseases of the chest (acute coronary syndrome)
- Diseases of the abdomen (gallbladder disease)
Where is pain from biceps tendinopathy typically?
Focused in the anterior shoulder with radiation distally over the biceps muscle
What movements aggravate biceps tendinopathy?
lifting, pulling, and repetitive overhead activities
What are some other patient complaints associated with biceps tendinopathy?
A painful arc of motion associated with a click and pain that worsens at night
When do acute tendon rupture usually occur?
During a specific traumatic event that causes sudden pain, a “pop,” ecchymosis, and swelling
In what type of patient is biceps tendon rupture difficult to diagnose and why?
- In obese populations, because the classic “Popeye” deformity may be obscured by adipose tissue
- Also in some elderly patients.
What are the 3 clinical tests used to diagnose biceps tendon injury?
- palpation
- Speed’s test
- Yergason’s test
What are 2 problems that occur when attempting to palpate the biceps tendon?
Palpating too distally and attempting to palpate with the shoulder internally rotated
Describe how Speed’s test is performed
1) patient’s arm is extended in full supination with the shoulder flexed
2) patient is asked to elevate the arm against a resisted isometric force applied by the examiner
Describe how Yergason’s test is performed
1) patient’s arm pronated and flexed at the elbow to 90 degrees
2) patient attempts to supinate the arm against a resisted isometric force applied by the examiner
When do Speed’s and Yergason’s test aid in diagnosis?
Only slightly when positive and never when negative
Do plain radiographs assist in diagnosing bicipital tendinopathy?
No, but they may assist in the evaluation of confounding shoulder pathology and can reveal subacromial spurring or anatomical variants of the acromion, which may lead to impingement and subsequent biceps tendon pathology
What 2 imaging techniques are the best for diagnosing biceps tendinopathy?
MRI and ultrasound
What are the 3 indications for orthopedic referral?
- Significant biceps tendon pain
- Cosmetic concerns
- Coexistent rotator cuff tears
What is the initial treatment regimen for biceps tendinopathy?
- Rest
- Anti-inflammatory medications
- NSAIDS
- PT (ROM and strengthening exercises for the biceps, rotator cuff, and scapular stabilizer muscle groups)
- Glucocorticoid injection into the subacromial space or the biceps tendon sheath
- iontophoresis with dexamethasone
What is a risk following glucocorticoid injection?
A postinjection rupture may occur as the patient, relieved of pain, prematurely pursues strenuous activities.
*activity should be avoided for 72 hours following an injection
What is the initial treatment regimen for biceps tendon rupture?
Ice, compression, and muscle rest
What is a reasonable follow-up interval for biceps tendinopathy?
2-4 weeks
What is the main complication of biceps tendinopathy?
biceps tendon rupture
In patients with long head biceps tendon rupture they may experience loss in and endurance of up to __%
25
