Bicipital Tendinopathy and SLAP Flashcards
general term that refers to chronic tendon pathology
Tendinopathy
inflammation of the synovial membrane covering a tendon.
Tenosynovitis
inflammation of a tendon; there may
be resulting scarring or calcium deposits.
Tendinitis
inflammation with thickening of a
tendon sheath.
Tenovaginitis
degeneration of the tendon due to
repetitive microtrauma.
Tendinosis
inflammation of the outer layer of the tendon (paratenon) alone.
Paratenonitis
paratenonitis associated with intratendinous degeneration.
Paratenonitis with tendinosis
what type of lesions show degenerative
fraying with no detachment of the
biceps insertion?
Type 1
what type of lesions show detachment of the
biceps insertion
Type 2
what type of lesions show a bucket handle
tear of the superior aspect of the
labrum with an intact biceps tendon
insertion to bone?
Type 3
what type of lesions show an intrasubstance
tear of the biceps tendon with a bucket
handle tear of the superior aspect of
the labrum?
Type 4
a Bankart lesion that extends superiorly to
include a Type II SLAP lesion.
Type 5
an unstable flap tear of the labrum in
conjunction with a biceps tendon separation.
Type 6
a superior labrum and biceps tendon
separation that extends anteriorly, inferior to the
middle glenohumeral ligament.
Type 7
pathological shoulder condition that deems an athlete
unable to throw due to pain and subjective unease in the shoulder – associated SLAP type II lesion as the MC pathology associated with the syndrome
Dead-arm syndrome
with the arm in the cocked position of abduction and lateral rotation the peel-back occurred. The change in angle and the twist of the biceps tendon produced a torsional force to the posterosuperior labrum, causing
detachment if the superior labrum was not well anchored to the glenoid
Peel-back phenomenon
– occurred as the biceps contracted to slow the rapidly extending elbow in the
follow-through phase
– believed that this created a high tensile load in the biceps that acted to pull
the biceps and superior labrum complex from the bone.
Deceleration Mechanism
– Occurs in late cocking, as the arm began to accelerate forward from an
abducted and laterally rotated position, the long head of the biceps and the
superior labrum were peeled back rather than pulled from the bone
Acceleration Mechanism
Clinical factors associated to dead-arm
syndrome:
– a tight posteroinferior capsule - > causes a GIRD and a shift in the glenohumeral rotation point
– the peel-back mechanism produced by the biceps tendon -> leads to a SLAP lesion,
– hyperexternal (lateral) rotation of the humerus
– scapular protraction.
Two cited causes of SLAP lesions
- FOOSH which drives the humeral head up
onto the labrum and the biceps tendon - excessive and forceful contraction of the
biceps in throwing athletes (e.g., baseball
and football players)
triangular-shaped area between the
supraspinatus and the subscapularis tendons
rotator interval
2 Classification of Biceps Tendonitis
Primary tendonitis & Secondary tendonitis
occurs as a result of
pathology of the tendon sheath
Primary tendonitis
occurs secondary to an
underlying injury that causes subsequent
biceps irritation and injury
Secondary tendonitis
three-part classification for
biceps lesions
Type A lesion
Type B lesion
Type C lesion
- referred to as impingement tendonitis
because it occurs secondary to an impingement
syndrome and rotator cuff disease. - Most common
Type A lesion
describe a subluxation of the biceps
tendon. All subluxations and dislocations of the biceps
tendon are included in this category.
Type B lesions
attrition tendonitis
type C lesion
Clinical Presentation of Biceps Lesions
• pain in the proximal anterior area of the shoulder directly over the biceps
tendon, with occasional radiation of pain down into the muscle belly
• pain can also be described at the deltoid insertion
• pattern of pain can be linked to repetitive types of activities
• Night pain
– compressive load may be present (e.g., lying on the affected shoulder)
or in some instances traction may be applied to the shoulder
– Position of comfort: lying on the contralateral side with the affected
arm in neutral, resting on the pillows
– Many patients with a painful shoulder report that their best rest is
achieved in a semireclined position, such as in a recliner, with the arm
resting on a pillow in the shoulder resting position
Labral Injury Mechanism
Deceleration mechanism & Acceleration mechanism
Arthrography
advantages:
shows biceps tendon subluxation, ruptures, dislocations
disadvantages:
invasive
sharp images of the tendon may be lost
Bicipital groove view radiography
advantages:
shows the width and medial wall of the bicipital groove, spurs in the groove
disadvantages:
does not show possible intra-articular d/o
MRI
advantages:
excellent evaluation for superior labral complex and biceps tendon
disadvantages:
partial tears of the biceps tendon are more difficult to detect than complete ruptures
expensive
Radiography
advantages:
R/O SH fx & strains or dislocations of the AC jt
disadvantages:
shows only bony origins of impingement syndrome and not soft tissue
Ultrasonography
advantages:
relatively inexpensive
dynamic
widely available
disadvantages:
requires experienced operator
high frequency array transducer
