Biceps Tendon Pathology Nonanchor Related

If the presenting complaint is pain at the front of the shoulder, especially if the point of maximal tenderness is reproduced with palpation in the area of the biceps tendon as described previously, a biceps tendon problem should be considered. Although the biceps tendon is normally difficult to palpate, there are a number of provocative maneuvers that can be considered to help confirm or rule out biceps tendon pathology. It should be remembered that many of these signs coexist with subacromial impingement.

Speed's Test

This is accomplished by having the patient hold the supinated arm in 90 degrees of forward flexion (Fig. 16-14). A positive test is marked by reproduction of pain with resisted forward

Figure 16-14 Speed's test.

flexion. This test has been shown to be 90% sensitive but only 14% specific for biceps tendon pathology.19

Yergason's Test

This test is performed by grasping the patient's hand as if to shake hands. The patient is asked to supinate while the examiner resists (Fig. 16-15). A positive test is reproduction of the pain at the front of the shoulder.

Ludington's Test

This is an observational test to look for a ruptured long head of the biceps. The patient is asked to place both palms of the hands on his or her head and flex the biceps. A positive test is marked by an asymmetrical biceps contour.

If these tests are positive, strong consideration should be given to an injection of the biceps tendon sheath as described later. If such an injection provides nearly complete relief in the office, especially with the subsequent normalization of the previously mentioned tests, one can be confident that the diagnosis of biceps tendon pathology is correct. This does not always address intra-articular biceps pathology (see SLAP Tears), and this differentiation can be confusing.

Figure 16-13 Active compression test (O'Brien's test).

Figure 16-15 Yergason's test.

Figure 16-13 Active compression test (O'Brien's test).

Figure 16-15 Yergason's test.

Figure 16-16 Palpation of bicipital groove.

It is difficult to exactly palpate the biceps tendon in its groove, and, thus, an injection can be difficult to place in the right anatomic location. The location of the biceps tendon and bicipital groove is commonly found with direct anterior palpation approximately 2 cm distal to the anterolateral corner of the acromion when the arm is in 10 degrees of internal rotation5,20 (Fig. 16-16). As this is very close to the insertions of the sub-scapularis and pectoralis major, care must be taken to rule out strains of these two muscles before assuming a diagnosis of biceps tendonitis.

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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