Biceps Tendiopathy and Tendon Rupture

Question 1

True or False

Biceps tendon ruptures can occur at both proximal and distal locations

Answer 1

True

Question 2

Biceps tendon injuries appear to occur more often among patients who do what?

Answer 2

engage in frequent pulling, lifting, reaching, or throwing for work or recreation

Rock climbers and weight lifters for example

Question 3

Where does the long head of the biceps brachii originate?

Answer 3

at the superior glenoid tubercle, where it contributes to the formation of the glenoid labrum

Question 4

Where does the short head of the biceps brachii originate?

Answer 4

at the coracoid process

Question 5

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

Answer 5

proximal

Question 6

What contributes to tendon injury within the bicipital groove, below the acromion, or at the labral attachment?

Answer 6

Dysfunction of the rotator cuff and scapular stabilizers

Question 7

The frequency of biceps tendon tears ____ with age

Answer 7

increases

Question 8

What is rupture of the proximal biceps tendon associated with?

Answer 8

RC tears

Question 9

What does the acute mechanism of distal biceps tendon rupture often involve?

Answer 9

a sudden traumatic extension of a flexed elbow when the biceps muscle is fully contracted

Question 10

Other than a RC tear, what are a few differential diagnoses for biceps tendinopathy?

Answer 10

• 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)

Question 11

Where is pain from biceps tendinopathy typically?

Answer 11

Focused in the anterior shoulder with radiation distally over the biceps muscle

Question 12

What movements aggravate biceps tendinopathy?

Answer 12

lifting, pulling, and repetitive overhead activities

Question 13

What are some other patient complaints associated with biceps tendinopathy?

Answer 13

A painful arc of motion associated with a click and pain that worsens at night

Question 14

When do acute tendon rupture usually occur?

Answer 14

During a specific traumatic event that causes sudden pain, a “pop,” ecchymosis, and swelling

Question 15

In what type of patient is biceps tendon rupture difficult to diagnose and why?

Answer 15

• In obese populations, because the classic “Popeye” deformity may be obscured by adipose tissue
• Also in some elderly patients.

Question 16

What are the 3 clinical tests used to diagnose biceps tendon injury?

Answer 16

• palpation
• Speed’s test
• Yergason’s test

Question 17

What are 2 problems that occur when attempting to palpate the biceps tendon?

Answer 17

Palpating too distally and attempting to palpate with the shoulder internally rotated

Question 18

Describe how Speed’s test is performed

Answer 18

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

Question 19

Describe how Yergason’s test is performed

Answer 19

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

Question 20

When do Speed’s and Yergason’s test aid in diagnosis?

Answer 20

Only slightly when positive and never when negative

Question 21

Do plain radiographs assist in diagnosing bicipital tendinopathy?

Answer 21

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

Question 22

What 2 imaging techniques are the best for diagnosing biceps tendinopathy?

Answer 22

MRI and ultrasound

Question 23

What are the 3 indications for orthopedic referral?

Answer 23

• Significant biceps tendon pain
• Cosmetic concerns
• Coexistent rotator cuff tears

Question 24

What is the initial treatment regimen for biceps tendinopathy?

Answer 24

• 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

Question 25

What is a risk following glucocorticoid injection?

Answer 25

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

Question 26

What is the initial treatment regimen for biceps tendon rupture?

Answer 26

Ice, compression, and muscle rest

Question 27

What is a reasonable follow-up interval for biceps tendinopathy?

Answer 27

2-4 weeks

Question 28

What is the main complication of biceps tendinopathy?

Answer 28

biceps tendon rupture

Question 29

In patients with long head biceps tendon rupture they may experience loss in and endurance of up to __%

Answer 29

25