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Condition/Disorder Synonyms

  • Bicipital tendonitis

  • Biceps tendinitis

  • Bicep tenosynovitis

  • Bicipital tenosynovitis

  • Calcific tendinitis

ICD-9-CM Code

  • 726.12 Bicipital tenosynovitis

ICD-10-CM Code

  • M75.20 Bicipital tendinitis, unspecified shoulder

Preferred Practice Pattern

Key Features

Description

  • 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)

Essentials of Diagnosis

  • 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

General Considerations

  • 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

Demographics

  • Predominately individuals involved in repetitive activities in sports or work

Clinical Findings

Signs and Symptoms

  • 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

Functional Implications

  • Limited overhead activities, especially lifting

  • Limited throwing and other rapid arm movements

Possible Contributing Causes

  • 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

Differential Diagnosis

  • Rotator cuff tendonitis

  • Rotator cuff impingement

  • Rotator cuff tear

  • Subacromial bursitis

  • Bicep tendinopathy

  • Bicep tear

  • Labral tear

Means of Confirmation or Diagnosis

Imaging

  • Radiographs ...

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