Bicipital Tendinopathy and SLAP

Question 1

general term that refers to chronic tendon pathology

Answer 1

Tendinopathy

Question 2

inflammation of the synovial membrane covering a tendon.

Answer 2

Tenosynovitis

Question 3

inflammation of a tendon; there may

be resulting scarring or calcium deposits.

Answer 3

Tendinitis

Question 4

inflammation with thickening of a

tendon sheath.

Answer 4

Tenovaginitis

Question 5

degeneration of the tendon due to

repetitive microtrauma.

Answer 5

Tendinosis

Question 6

inflammation of the outer layer of the tendon (paratenon) alone.

Answer 6

Paratenonitis

Question 7

paratenonitis associated with intratendinous degeneration.

Answer 7

Paratenonitis with tendinosis

Question 8

what type of lesions show degenerative
fraying with no detachment of the
biceps insertion?

Answer 8

Type 1

Question 9

what type of lesions show detachment of the

biceps insertion

Answer 9

Type 2

Question 10

what type of lesions show a bucket handle
tear of the superior aspect of the
labrum with an intact biceps tendon
insertion to bone?

Answer 10

Type 3

Question 11

what type of lesions show an intrasubstance
tear of the biceps tendon with a bucket
handle tear of the superior aspect of
the labrum?

Answer 11

Type 4

Question 12

a Bankart lesion that extends superiorly to

include a Type II SLAP lesion.

Answer 12

Type 5

Question 13

an unstable flap tear of the labrum in

conjunction with a biceps tendon separation.

Answer 13

Type 6

Question 14

a superior labrum and biceps tendon
separation that extends anteriorly, inferior to the
middle glenohumeral ligament.

Answer 14

Type 7

Question 15

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

Answer 15

Dead-arm syndrome

Question 16

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

Answer 16

Peel-back phenomenon

Question 17

– 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.

Answer 17

Deceleration Mechanism

Question 18

– 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

Answer 18

Acceleration Mechanism

Question 19

Clinical factors associated to dead-arm

syndrome:

Answer 19

– 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.

Question 20

Two cited causes of SLAP lesions

Answer 20

• 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)

Question 21

triangular-shaped area between the

supraspinatus and the subscapularis tendons

Answer 21

rotator interval

Question 22

2 Classification of Biceps Tendonitis

Answer 22

Primary tendonitis & Secondary tendonitis

Question 23

occurs as a result of

pathology of the tendon sheath

Answer 23

Primary tendonitis

Question 24

occurs secondary to an
underlying injury that causes subsequent
biceps irritation and injury

Answer 24

Secondary tendonitis

Question 25

three-part classification for | biceps lesions

Answer 25

Type A lesion Type B lesion Type C lesion

Question 26

- referred to as impingement tendonitis because it occurs secondary to an impingement syndrome and rotator cuff disease. - Most common

Answer 26

Type A lesion

Question 27

describe a subluxation of the biceps tendon. All subluxations and dislocations of the biceps tendon are included in this category.

Answer 27

Type B lesions

Question 28

attrition tendonitis

Answer 28

type C lesion

Question 29

Clinical Presentation of Biceps Lesions

Answer 29

• 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

Question 30

Labral Injury Mechanism

Answer 30

Deceleration mechanism & Acceleration mechanism

Question 31

Arthrography

Answer 31

advantages: shows biceps tendon subluxation, ruptures, dislocations disadvantages: invasive sharp images of the tendon may be lost

Question 32

Bicipital groove view radiography

Answer 32

advantages: shows the width and medial wall of the bicipital groove, spurs in the groove disadvantages: does not show possible intra-articular d/o

Question 33

MRI

Answer 33

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

Question 34

Radiography

Answer 34

advantages: R/O SH fx & strains or dislocations of the AC jt disadvantages: shows only bony origins of impingement syndrome and not soft tissue

Question 35

Ultrasonography

Answer 35

advantages: relatively inexpensive dynamic widely available disadvantages: requires experienced operator high frequency array transducer