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  • Bicipital tendonitis
  • Biceps tendinitis
  • Bicep tenosynovitis
  • Bicipital tenosynovitis
  • Calcific tendinitis

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  • 726.12 Bicipital tenosynovitis

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  • M75.20 Bicipital tendinitis, unspecified shoulder

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Description

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  • Inflammation, irritation, swelling of the long head of biceps tendon
  • Occurs most often from repetitive motion injuries or impingement syndrome, but can occur with sudden strain/stress to the tendon, or with rotator cuff tendonitis or pathology
  • Early stages
    • Tendon becomes swollen and red
    • As tendonitis develops, the tendon sheath may thicken
  • Late stages
    • Chronic inflammation may result in fraying of the tendon
    • May progress to rupture with long term inflammation
  • Rupture will cause bulging, bruising, and gathering of the muscle (“Popeye” sign may indicate rupture)

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Essentials of Diagnosis

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  • History and clinical exam
  • Look for signs of pain with A/PROM, resistance, palpation, and specific tests for the bicep tendon
  • Pain with palpation of the bicipital groove with arm at 10 degrees of internal rotation
  • Pain with passive stretch of the bicep

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General Considerations

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  • History of repetitive motion, especially activities overhead
  • Common in swimming, tennis, baseball, and with occupational activities involving repetitive or overhead activity due to micro trauma
  • Can be seen in individuals with other system-wide diseases such as rheumatoid arthritis or diabetes
  • Often occurs secondary to impingement syndrome or rotator cuff injury

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Demographics

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  • Predominately individuals involved in repetitive activities in sports or work

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Signs and Symptoms

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  • Ache in the anterior medial or anterior lateral aspect of the shoulder
    • Frequently worsens with overhead lifting or activity
  • Pain or ache with palpation at the bicipital groove that may travel down the anterior upper arm
  • Occasional snapping sound or sensation
  • Full A/PROM, though pain may occur at the end ROM
  • Pain with resisted elbow-flexion or resisted forward-flexion of the shoulder
  • Pain with passive stretch of the bicep
  • Positive special tests for the biceps

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Functional Implications

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  • Limited overhead activities, especially lifting
  • Limited throwing and other rapid arm movements

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Possible Contributing Causes

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  • Frequent and prolonged overhead activity
  • Prolonged repetitive use of the involved arm
  • Poor posture (rounded shoulders)
  • Anteriorly displaced humeral head
  • Rotator cuff weakness
  • Aging
  • Systemic diseases, such a rheumatoid arthritis or diabetes
  • Previous bicipital injury

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Differential Diagnosis

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Imaging

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  • Radiographs looking for calcification or boney abnormalities
  • MRI

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  • Radiographs may show calcification or other boney abnormalities of the shoulder
  • MRI to evaluate soft tissue for structural changes or rupture
  • Swelling may be apparent

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Medication

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