Bicipital Tendinosis Lowe

Question 1

What is Bicipital Tendinosis?

Answer 1

long or short heads of biceps are susceptible to the collagen degeneration process of tendinosis; long head is more vulnerable due to increased friction in bicipital groove

Question 2

Characteristics:

Answer 2

biceps long head tendon makes a right-angled turn as it courses across the top of the humerus before attaching to the supraglenoid tubercle of the scapula; the turn increases friction between bone and tendon; tendon surrounded by synovial sheath to reduce friction against bicipital groove; can be the site of tenosynovitis and tendinosis; upper portion of the tendon is pressed into the groove where it maintains the position of the humeral head and prevents dislocation; tendinosis can affect any part of tendon but most prevalent in the upper portion

-repetitive motions involving flexion of the shoulder, elbow or supination of the forearm can cause chronic tendon overload; often result of occupational activities; cumulative stress leads to collagen degeneration

-can also result from impingement of the tendon under the coracoacromial arch; pain is similar to rotator cuff tears or tendinosis; often misdiagnosed; rarely the result of acute trauma, gradual onset of symptoms

-the tendon has fibrous attachments to the superior margin of the glenoid labrum so consistent tensile loads that produce tendinosis may also cause tearing or damage to the labrum and cause a SLAP lesion

Question 3

History:

Answer 3

diffuse, aching pain in anterior shoulder, may radiate to elbow, aggravated by elbow flexion or forearm supination with significant resistance; worse during overhead motion or when lifting/pulling heavy objects; repetitive elbow or shoulder activity prior to symptom onset; rest relieves symptoms; may be pain at onset of activity, subsides during and then recurs later

Question 4

Observation:

Answer 4

no visual factors; patterns of movement restriction cause by pain avoidance (active shoulder flexion)

Question 5

Palpation:

Answer 5

tenderness over long head of biceps brachii, increases when pressure applied during resisted contraction; may be hypertonicity in shoulder muscles, myofascial trigger points may develop in response to tissue dysfunction

Question 6

Range of Motion and Resistance Testing

Answer 6

AROM: pain with active flexion of shoulder due to impingement of tendon under coracoacromial arch and not from load on the tendon; pain unlikely with elbow flexion or forearm supination (not enough tension to stress tendon); may be pain with elbow and shoulder extension at end range

PROM: as with AROM; may be pain at end of shoulder extension from stretching of muscle-tendon unit
and pulling long head of biceps against anterior humeral head

MRT: may be pain and/or weakness during shoulder flexion, elbow flexion, supination or combination;
effectively isolate long head of biceps brachii with elbow flexion and supination

Question 7

Special Tests:

Answer 7

Speed’s: standing; 90° shoulder flexion, elbow fully extended, forearm supinated; patient attempts to hold position as practitioner applies downward pressure at wrist; if pain reproduced during contraction and resistance, positive test
Variation: therapist pushes patient’s arm towards floor while patient slowly releases contraction; pain felt during the eccentric movement is a positive test (more challenging to resist)
-all three actions of biceps brachii are engaged simultaneously, increased load reproduces patient’s symptoms; during the variation, the long head of biceps slides in bicipital groove as shoulder moves into extension; if there is tendinosis/tenosynovitis, primary pain is reproduced

Question 8

Differential Evaluation:

Answer 8

shoulder impingement syndrome, subacromial bursitis, upper extremity nerve entrapments, acromioclavicular joint pathology, rotator cuff disorders, glenoid labrum damage, frozen shoulder/ adhesive capsulitis, arthritis

Question 9

Suggestions for Treatment:

Answer 9

reduce tension on affected muscle-tendon unit with stripping and broadening techniques, effleurage and superficial sweeping cross-fibre techniques; deep frictions to address collagen degeneration; avoid transverse frictions because tendon may be subluxed from bicipital groove if transverse humeral ligament is weak