Biceps Tendinopathy

Pain, tenderness and inflammation around long head of biceps tendon often caused due to overuse injury among older patients especially older athletes ( 30+ age athletes and old aged patients 60+ age).

Pain often resembles Shoulder impingement syndrome, Rotator cuff tendinopathy.

EPIDEMIOLOGY

Occurs more commonly while performing or after sporting activities like lifting, throwing, overhead movement.

In UK prevalence rate of biceps tendon rupture is 0.53/100,000 over 5 years, with male:female ratio 3:1.

PATHOPHYSIOLOGY

Repetitive irritation friction leads to swelling of tendon initially.

Continued irritation, traction, friction makes tendon thicker.

Eventually long term irritation leads to adhesion formation around surrounding structures.

CLINICAL FEATURES

Patients with biceps tendinopathy often complain of a deep, throbbing pain in the anterior shoulder that is intensified when lifting.

Patients are likely to present with a chief complaint of anteromedial shoulder pain The pain is usually localized to the bicipital groove and may radiate toward the insertion of the deltoid muscle or along radial distribution

Pain may be aggravated by overhead reaching, pulling and lifting activities. The pain usually worsens at night when sleeping on the affected shoulder.

Pain with palpation over the bicipital groove is another physical exam finding in patients with biceps tendinopathy. Active elbow flexion may also provoke pain. Cases associated with biceps instability, the patient may complain of an anterior shoulder “clicking” or “popping” sensation associated with throwing motions.

PHYSICAL EXAMINATION AND DIAGNOSIS

Physical examination includes Active And Passive ROM testing, Palpation, Clinical Screening and Specific tests

Biceps Tendon tests

SPEED TEST

Resisted shoulder flexion with elbow extended and forearm supinated

Positive if pain felt in bicipital groove

YERGASON TEST

Elbow flexed at 90°. Initially pronated

Active Supination and flexion against resistance

Pain at bicipital groove yields positive result

DIFFERENTIAL DIAGNOSIS AND MEASURES

SLAP Lesion

Glenohumeral Instability

OsteoArthritis

Sub-Acromial Impingement

Scales used to measure is

DASH (Disability of Arm, Shoulder and Hand)

PHYSIOTHERAPY MANAGEMENT

Physical therapy has been commonly used for the treatment of tendinopathies, especially eccentric training.

Intervention should include restoration of pain free range of motion, trunk and core stability and ensuring stable scapulothoracic rhythm. Pain free range can be achieved with such activities as Passive Range of Motion, Active Assisted Range of Motion, and mobilization. Painful activities such as abduction and overhead activities should be avoided in the early stages of recovery as it can exacerbate symptoms.

Initial Conservative Management includes application of ice to the affected area for 10-15 minutes, 2-3 times per day for the first 48 hours. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are used for 3-4 weeks to treat inflammation and pain

Stretching and strengthening regimes are a common aspects of most therapy protocols. Therapists also use other modalities like ultrasound, iontophoresis, deep transverse friction massage, low-level laser therapy, Hot fermentation.

Rehabilitation Exercise Regime includes

Active Elbow Flexion and Extension

Biceps Stretch

Biceps Curl

Single arm Shoulder flexion

Resisted Shoulder Internal Rotation

Resisted Shoulder External Rotation

Sleeper Stretch

Side lying External Rotation