Bicipital tendinitis

Bicipital tendinitis may rarely occur as an isolated problem in young people following vigorous or unaccustomed exercise of the shoulder. Biceps tendinopathy (tendinitis) is commonly accompanied by rotator cuff tears or SLAP (superior labrum anterior to posterior) lesions.

• classically presents with a dull ache in the anterior shoulder
  • repetitive overhead motion of the arm initiates or exacerbates the symptoms
• clinical examination includes point tenderness on the biceps tendon found overlying the anterior part of the shoulder in the groove between anterior deltoid and pectoralis major
  • Pain may be exacerbated by:
    • resisted straight arm flexion and external rotation of the arm at 90º (Speed's test)
      • click here for video of Speed's test
      • or
    • resisted supination with the elbow at 90º (Yergason's test)
      • click here for video of Yergason's test

Investigation

• diagnosis of biceps tendinopathy should be made clinically
• ultrasound
  • can be useful to confirm a clinical diagnosis or to guide a therapeutic injection of lidocaine and hydrocortisone. The tendon sheath is continuous with the glenohumeral joint, and therefore fluid in the tendon sheath may be secondary to a glenohumeral joint effusion. If ultrasound is requested the glenohumeral joint and rotator cuff should also be assessed at the same time
• Magnetic resonance imaging (MRI)
  • may be useful in picking up any intra-articular pathology such as a SLAP lesion and should be considered in athletes participating in throwing sports presenting with shoulder pain and biceps tendinopathy

Management:

• conservative treatment (rest, heat and deep transverse friction), is usually sufficient. A corticosteroid injection may be performed in skilled hands, though the integrity of the tendon may already be impaired and there is a risk of post-injection tendon rupture
• surgery, in the form of anterior acromioplasty, may rarely be indicated where non-operative treatment is ineffective.

Reference:

1. Murphy RJ, Bintcliffe F; Ask the expert: assessment of shoulder pain in primary care. BMJ. 2023 Jul 7;382:1255.