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Bicipital Tendonitis

Bicipital Tendonitis is an inflammatory process of the long head tendon and is a common cause of shoulder pain due to its position and function. The tendon is exposed on the anterior shoulder as it passes through the humeral bicipital groove and inserts on the superior aspect of the labrum of the glenohumeral joint. Disorders can result from impingement or as an isolated inflammatory injury. Other causes are secondary to compensation to rotator cuff disorders, labral tears, and intra-articular pathology.


Diagnosis of Bicipital Tendonitis

Local tenderness usually is present over the bicipital groove, which typically is located 3 inches below the anterior acromion and may be localized best with the arm in 10 of external rotation.

Flexion of the elbow against resistance aggravates pain.

Passive abduction of the arm in a painful arc maneuver typical of impingement syndrome may elicit pain; however, this finding may be negative in isolated biceps tendonitis.

Speed test: Patient complains of anterior shoulder pain with flexion of the shoulder against resistance, while the elbow is extended and the forearm is supinated.

Yergason test: The patient complains of pain and tenderness over the bicipital groove with forearm supination against resistance with the elbow flexed and the shoulder in adduction. Popping of subluxation of the tendon may be demonstrated with this maneuver.

The remainder of the examination should be to document active and passive range of motion (ROM) and joint stability in order to assess the rotator cuff and glenoid labrum. A complete evaluation includes a complete neurovascular assessment as well.

Biceps tendonitis with labral tears or rotator cuff tears may not improve if all the diagnoses are not treated.


Causes of Bicipital Tendonitis

The long head tendon passes down the bicipital groove in a fibrous sheath between the subscapularis and supraspinatus tendons. This relationship causes the tendon to undergo degenerative and attritional changes associated with rotator cuff disease because it shares the associated inflammatory process within the suprahumeral joint.

Full humeral head abduction places the attachment area of the rotator cuff and biceps tendon under the acromion. External rotation of the humerus at or above the horizontal level compresses these suprahumeral structures into the anterior acromion. Repeated irritation leads to inflammation, edema, microscopic tearing, and degenerative changes.

In younger athletes, relative instability due to hyperlaxity may cause similar inflammatory changes on the bicipital tendon due to excessive motion of the humeral head.

Labral tears may disrupt the biceps anchor, resulting in dysfunction causing pain.

Other diagnostic considerations: The transverse humeral ligament holds the biceps tendon long head within the bicipital groove. Injuries and disruption of the ligament can lead to subluxation and medial dislocation of the tendon

Modified 8-1-03
Information compiled from the National Institutes of Health


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