Abstract
The pain of bicipital tendinitis is constant and severe and is localized in the anterior shoulder over the bicipital groove. A catching sensation may accompany the pain. Significant sleep disturbance is often reported. The patient may attempt to splint the inflamed tendons by internal rotation of the humerus, which moves the biceps tendon from beneath the coracoacromial arch. Patients with bicipital tendinitis have a positive Yergason’s test. The tendons of the long and short heads of the biceps are particularly susceptible to the development of tendinitis. Bicipital tendinitis is usually caused at least partially by impingement on the tendons of the biceps at the coracoacromial arch. The onset of bicipital tendinitis is generally acute, occurring after overuse or misuse of the shoulder joint, such as trying to start a recalcitrant lawn mower, practicing an overhead tennis serve, or performing an overaggressive follow-through when driving golf balls. The biceps muscle and tendons are susceptible to trauma and to wear and tear. If the damage is severe enough, the tendon of the long head of the biceps can rupture, leaving the patient with a telltale “Popeye” biceps (named after the cartoon character). This deformity can be accentuated by having the patient perform Ludington’s maneuver: placing his or her hands behind the head and flexing the biceps muscle.
Keywords
bicipital tendinits, shoulder pain, biceps tendon, Ludington maneuver, Popeye, sign, biceps tendon injection, ultrasound guided injection, tendinopathy
ICD-10 CODE M75.20
The Clinical Syndrome
The tendons of the long and short heads of the biceps are particularly susceptible to the development of tendinitis. Bicipital tendinitis is usually caused at least partially by impingement on the tendons of the biceps at the coracoacromial arch. The onset of bicipital tendinitis is generally acute, occurring after overuse or misuse of the shoulder joint, such as trying to start a recalcitrant lawn mower, practicing an overhead tennis serve, or performing an overaggressive follow-through when driving golf balls. The biceps muscle and tendons are susceptible to trauma and to wear and tear. If the damage is severe enough, the tendon of the long head of the biceps can rupture, leaving the patient with a telltale “Popeye” biceps (named after the cartoon character). This deformity can be accentuated by having the patient perform Ludington’s maneuver: placing his or her hands behind the head and flexing the biceps muscle (see Chapter 31 ).
Signs and Symptoms
The pain of bicipital tendinitis is constant and severe and is localized in the anterior shoulder over the bicipital groove ( Fig. 28.1 ). A catching sensation may accompany the pain. Significant sleep disturbance is often reported. The patient may attempt to splint the inflamed tendons by internal rotation of the humerus, which moves the biceps tendon from beneath the coracoacromial arch. Patients with bicipital tendinitis have a positive Yergason’s test result—that is, production of pain on active supination of the forearm against resistance with the elbow flexed at a right angle ( Fig. 28.2 ). Bursitis often accompanies bicipital tendinitis.
In addition to pain, patients suffering from bicipital tendinitis often experience a gradual reduction in functional ability because of decreasing shoulder range of motion that makes simple everyday tasks such as combing one’s hair, fastening a brassiere, and reaching overhead quite difficult. With continued disuse, muscle wasting may occur, and a frozen shoulder may develop.
Testing
Plain radiographs are indicated for all patients who present with shoulder pain. Based on the patient’s clinical presentation, additional testing may be indicated, including a complete blood count, erythrocyte sedimentation rate, and antinuclear antibody testing. Magnetic resonance and ultrasound imaging of the shoulder is indicated if rotator cuff tear is suspected and to further delineate shoulder pathology ( Figs. 28.3 and 28.4 ). Arthroscopy can aid in the diagnosis and treatment of bicipital tendinitis in selected patients ( Fig. 28.5 ). The injection technique described later serves as both a diagnostic and a therapeutic maneuver.
