II. Types

  1. Primary Biceps Tendinitis (5% of cases)
    1. Inflammation within bicipital groove
    2. Long head of biceps tendon and sheath
  2. Secondary Biceps Tendinitis (95% of cases)
    1. Rotator Cuff Tear or
    2. Superior Labrum Anterior to Posterior Tear (SLAP Lesion)

III. Risk factors

  1. Biceps tendon impingement primary causes (impingement under coracoacromial arch)
    1. Acromion bone spur
    2. Unfused acromial apophysis
    3. Coracoacromial ligament thickening
  2. Biceps tendon impingement secondary causes
    1. Scapular instability
    2. Shoulder ligamentous instability
    3. Lax anterior capsule
    4. Tight posterior capsule
    5. Labral Tear
    6. Rotator Cuff Tear
    7. Osteoarthritic spurs at bicipital groove
  3. Associated activities at higher risk for acute Tendinitis or chronic overuse Tendinosis
    1. Repetitive throwing
    2. Contact Sports
    3. Swimming
    4. Gymnastics
    5. Martial arts
  4. Secondary inflammation due to Arthritis (tendon originates inside Shoulder joint)
    1. Rheumatoid Arthritis
    2. System lupus erythematosus
    3. Reactive Arthritis
    4. Septic Arthritis

IV. Background: Anatomy

  1. Images
    1. ShoulderAnteriorBiceps.jpg
  2. Long head of biceps
    1. Originates at supra-glenoid tubercle (anterior superior aspect adjacent to glenoid fossa)
    2. Travels laterally through Shoulder joint in front of Humerus
    3. Descends under the transverse humeral ligament and into the bicipital groove
      1. Transverse humeral ligament acts as a pulley, reorienting the tendon inferiorly
      2. Landmarks: Groove lies between greater tuberosity (lateral) and less tuberosity (medial)

V. Symptoms

  1. Anterior Shoulder, deep throbbing ache
  2. Radiation along bicipital groove into hand or into deltoid tendon insertion
  3. Provocative factors
    1. Sleeping on affected Shoulder
    2. Repetitive motion (overhead activity, pulling, lifting)
    3. Worse during follow-through of throwing motion

VI. Signs

  1. Tenderness over bicipital groove
  2. Biceps Tendon Instability may cause a palpable or audible snap on range of motion testing
  3. Pain limits active and passive range of motion
  4. Maneuvers that stretch biceps elicit pain
    1. Forceful external rotation with abduction (shifts bicipital groove to a posterolateral position)
    2. Arm extension with elbow extended
  5. Yergason Test
  6. Speed's Test

VII. Differential Diagnosis

  1. Rotator Cuff Impingement or Rotator Cuff Tear
  2. Cervical Disc Disease

VIII. Precautions

  1. Bicipital Tendon Injury is commonly associated with Rotator Cuff Injury or SLAP Lesion

IX. Management

  1. Acute management (until pain resolves)
    1. Rest
    2. Moist heat
    3. Gentle range of motion
    4. NSAIDs
    5. Avoid motion that stretches biceps tendon (especially overhead motion)
    6. Sling temporarily if needed (but avoid immobility due to risk of Frozen Shoulder)
  2. Rehabilitation Exercises (start when pain free)
    1. Step 1: StretchingExercises
      1. Shoulder specific Stretching: Scapula, Rotator Cuff and Posterior Capsule
      2. Hamstrings
      3. Low Back
    2. Step 2: Strengthening Exercises
      1. Rotator cuff Muscles
      2. Scapular rotator Muscles
      3. Humeral motion Muscles (pectoralis major, latissimus dorsi, and deltoid Muscles)
    3. Step 3: Throwing program (athletes)
  3. Biceps Tendon Injection
    1. Local Corticosteroid Injection at tendon sheath under Ultrasound guidance (see Shoulder Ultrasound)
    2. Approached in-plane to linear Ultrasound probe (probe short axis to anterior Shoulder - home position)
    3. Do not inject within tendon (and avoid circumflex artery within groove)
    4. May also help differentiate rotator cuff source of pain from primary Bicipital Tendinitis
  4. Surgery is indicated for failed conservative therapy after 3 months
    1. Partial Biceps Tendon Rupture (<50%): Debridement
      1. Debridement of impinging structures
    2. Ruptured tendon and age <60, athletes or otherwise active: Biceps tenodesis
      1. Tendon anchored in the bicipital groove
    3. Ruptured tendon and age over 60 years: Biceps tenotomy
      1. Biceps tendon removed from glenohumeral joint without loss of function

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Biceps tendinitis (C0151434)

Concepts Disease or Syndrome (T047)
ICD10 M75.2
SnomedCT 202893001, 268087008, 156658000, 202856007
English bicipital tendonitis, bicipital tendonitis (diagnosis), bicep tendinitis, biceps tendinitis, tendinitis bicipital, bicipital tendinitis, Tendonitis bicepital, Bicipital tendinitis-shoulder, Biceps tendinitis (long head), Bicepital tendonitis, Bicipital tendinitis, Biceps tendinitis, Biceps tendinitis (disorder), biceps; tendinitis, tendinitis; biceps
German Tendinitis des M. biceps brachii
Korean 이두근 힘줄염
Dutch biceps; tendinitis, tendinitis; biceps, Tendinitis bicipitalis
Spanish tendinitis bicipital, tendinitis del bíceps (trastorno), tendinitis del bíceps

Ontology: Bicipital tenosynovitis (C0158304)

Concepts Disease or Syndrome (T047)
ICD9 726.12
SnomedCT 202840002, 41137001
Dutch tendovaginitis van biceps, biceps; tendovaginitis, tendovaginitis; biceps
French Ténosynovite bicipitale
German Bizeps-Tenosynovitis
Italian Tenosinovite del bicipite
Portuguese Tenossinovite bicipital
Spanish Tenosinovitis bicipital, tenosinovitis bicipital (trastorno), tenosinovitis bicipital
Japanese 上腕二頭筋長頭腱炎, ジョウワンニトウキンチョウトウケンエン
Czech Tendosynovitida bicepsu
Hungarian Bicipitalis tendovaginitis
English Bicipital tenosynovitis, Bicipital tenosynovitis (disorder), biceps; tenosynovitis, tenosynovitis; biceps