Daily Bolus of LR: Bicipital Tendinitis

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March 22, 2011 by dailybolusoflr

Biciptial tendinitis

 

·         Bicipital tendinitis is a local inflammatory process of the long head of the biceps tendon and its sheath

·         It is most commonly found in patients who work with their arms overhead

·         Patients with most commonly complain of an aching pain in their anterior shoulder which is made worse by lifting their arm or by using the arm in an elevated position

·         The following shows the location of the biceps tendon

 

http://www.mdguidelines.com/images/Illustrations/bic_tend.jpg

 

Examination

·         Tenderness, which is best localized with the arm in 10 º of external rotation, is usually present over the bicipital groove, which is typically located 3 inches below the anterior acromion.

·         Flexion of the elbow against resistant aggravates the patient’s pain.

 

Two maneuvers which can be performed to assist in diagnosis are the following.

·         The 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.
www.mhhe.com/…/athletictraining/ch22.mhtml   Click on Figure 22-17 A

 

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

www.mhhe.com/…/athletictraining/ch22.mhtml   Click on Figure 22-17 B

 

Radiographs are rarely helpful (except to assist in ruling out traumatic or pathologic fractures).  The only finding which may be consistent is calcification along the tendon, but this does not confirm the diagnosis.

Treatment may involve NSAIDs, injection with anesthetic and long acting steroids (this can also serve as diagnosis if the patients symptoms abate with injection of the area), rest and subsequent PT.

 

 

Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions

 

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