This video provides a comprehensive overview of biceps tendonitis, also referred to as biceps tendinopathy (0:07).
Here's a breakdown of the key information:
Definition and Symptoms (0:26): Biceps tendonitis is essentially a strain or damage to the biceps muscle or its tendon. It can range from a few interrupted fibers to a complete tendon rupture (0:43).
Signs and Symptoms: Patients typically experience pain and weakness (0:47).
Point Tenderness: Pain can be localized to the bicipital groove (1:00).
Popeye Sign: A complete rupture may present with a "Popeye sign," where the biceps muscle balls up in the middle of the upper arm (1:17).
Anatomy of the Biceps (1:41):
Two Heads: The biceps has two heads: the short head originates from the coracoid process (1:45), and the long head originates from the superior glenoid/labrum (1:47).
Insertion: Both heads insert into the bicipital aponeurosis on the radius (2:03).
Primary Action: While a powerful elbow flexor, its primary action is supination (2:11).
Nerve Innervation: The muscular cutaneous nerve (2:35), with the biceps reflex usually associated with C5 (2:38).
Differential Diagnosis (2:41):
Rotator Cuff Tendonitis: Pain can be confused with supraspinatus issues (3:01).
Impingement: Subacromial pain can be hard to localize and mistaken for biceps issues (3:07).
Labral Tear: The long head of the biceps inserts into the superior labrum, making labral tears a consideration (3:29).
Coracoid Process Pain: Pain around the coracoid process can be due to the short head of the biceps, coracobrachialis, or pec minor (3:41).
Special Tests (3:59):
Speed's Test (Gold Standard): Performed with shoulder flexion, slight external rotation, extended elbow, and supinated forearm against resistance (4:06). Pain indicates a positive test (4:24).
Yergason's Test: Performed with 90 degrees of elbow flexion and supination, attempting to extend the elbow against resistance (4:41). Pain indicates a positive test (4:57).
O'Brien's Test: Used to differentiate with a SLAP tear. Involves shoulder flexion, horizontal adduction, pronation, and internal rotation against resistance, then supination and re-resisting (5:01). Less pain with supination is a positive sign for a SLAP tear (5:28).
Causes of Biceps Tendonitis (5:46):
Overhead sports (5:49)
Lifting heavy weights (5:50)
Eccentric action of the biceps during the slowing phase of pitching (5:53)
Multiple corticosteroid shots in the shoulder (6:02)
Treatment (6:06):
Physical Therapy: Focuses on strength restoration, pain management (modalities, NSAIDs), and postural retraining (6:08).
Post-Surgery Precautions: If surgery is performed (e.g., SLAP repair), precautions similar to rotator cuff repairs are followed, including avoiding biceps contractions, external rotation, and often using a sling for 2-4 weeks (6:30).
Example Question: SLAP Lesion Post-Op (6:56):
Scenario: A patient one week post-SLAP lesion repair.
Question: What treatment would you implement?
Choices:
Active range of motion into external rotation.
Strengthen the scapular stabilizers.
Joint mobilizations to increase glenohumeral extension.
Isometric biceps exercise.
Correct Answer: Strengthen the scapular stabilizers (7:36).
Explanation: Early post-op, it's crucial to protect the repair (7:39). Active external rotation would damage the repair (7:50). Joint mobilizations are generally too aggressive one week post-op (8:13). Isometric biceps exercises, while seemingly safe, can generate significant force and damage the tendon repair (8:25). In the acute phase, focus on pain management, edema reduction, and patient education (9:00).
