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153: BICIPITAL TENDINOSIS

E. Thomas Pitney, DPT, PT, SCS, ATC; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Biceps tendinitis

  • Biceps tendonitis

  • Bicep tenosynovitis

  • Bicipital tenosynovitis

ICD-9-CM CODE

  • 726.12 Bicipital tenosynovitis

ICD-10-CM CODE

  • M75.20 Bicipital tendinitis, unspecified shoulder

PREFERRED PRACTICE PATTERN

  • 4E: Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation1

PATIENT PRESENTATION

This patient is a 45-year-old male who recently returned to a fitness center exercise program. He began to experience pain in the anterior shoulder and upper one-third of the arm after significantly increasing resistance with his upper body program, especially taking preacher curls to fatigue failure and doubling his weight over a 2-week period. The patient has specific tenderness over the bicipital groove and the long head of the bicep tendon to the musculotendinous junction. Resistive elbow flexion is painful in the same region and is 4-/5 compared to 5/5 through the remainder of the shoulder girdle. A/PROM is full and symmetrical with the uninvolved side. Speed’s test is positive and Neer and Hawkins-Kennedy tests are negative. There is no visible deformity, swelling, or asymmetry of appearance.

KEY FEATURES

Description

  • Irritation 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 tendinosis develops, the tendon sheath may thicken

  • Late stages

    • Chronic irritation may result in fraying of the tendon or necrosis

    • May progress to rupture

  • Rupture will cause bulging, bruising, and gathering of the muscle (“Popeye” sign may indicate rupture)

FIGURE 153-1

Biceps (C5, 6; musculocutaneous nerve). The supinated forearm is flexed against resistance. (From Waxman SG. Clinical Neuroanatomy. 26th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Essentials of Diagnosis

  • History and clinical examination

  • 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 ...

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