Biceps tendinitis/Tendinopathy
What is it?
What is the cause?
Pain referral pattern:
Diagnostic tool to rule in/out:
Presentation of the disease:
- In 1970 research by Neer defined biceps tendinitis as a secondary problem as a result of impingement syndrome. Neer concluded that it is not a primary pain generator rather a result of another shoulder pathology most notably a rotator cuff disorder/pathology.
- It was later classified in two categories, primary bicipital tendinitis and secondary bicipital tendinitis. Both defined by an inflammatory condition.
- Primary tendinitis is defined when the patient has isolated problem of the biceps tendon, it is often seen in younger patients and may be related to abnormality of the bicipital groove, possibly from previous trauma. These patients are at high risk for eventual rupture of the tendon
- Secondary tendinitis is defined as by an association with other underlying shoulder problems which is the most common type and may account for approximately 95% of cases.
- Tendinitis is classified as an inflammatory condition but can become a primary degenerative pathology as it rubs on the coacromial arch.
What is the cause?
- Primary is caused by an abnormality of the bicipital groove in younger patients.
- Secondary is caused by underlying shoulder abnormalities such as impingement syndrome.
- Patient will present with pain in the anterior shoulder that may extend into the biceps. The patient may feel instability in the biceps tendon. The patient may also present with an audible snap or pop when throwing. No history of trauma.
- Patient will have point tenderness or pain in the bicipital groove.
Pain referral pattern:
- Pain is usually referred to the anterior shoulder or into the biceps tendon.
Diagnostic tool to rule in/out:
- Speed test- the patient holds the elbow in extension with the forearm supinated and then flexes the shoulder against resistance, thus reproducing the patient's pain (Video available here)
- Yergason test- the patient supinates the forearm against resistance with the forearm flexed thus reproducing the pain.
- A positive test result occurs when pain refers to the bicipital groove. Instability should be evaluated by placing the arm in abduction and external rotation and then slowly bringing it down to the patient's side. A palpable snap signifies a positive test result as the tendon sub luxes.
Presentation of the disease:
- Pain in the anterior shoulder extending into the biceps and point tenderness to palpation of the biceps tendon.