Biceps tendinopathy - TM Flashcards

1
Q

What is biceps tendinopathy?

A
  • Variety of pathological changes within tendon
  • = painful, swollen, structurally weaker and increase risk of rupture
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2
Q

Where can biceps tendinopathy occur?

A
  • Proximal or distal bicep
  • In younger active people esp sports with repetitive flexion and older individuals with degenerative changes
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3
Q

Clinical features tendinopathy

A
  • Pain
  • Worsened with stressing the tendon
  • Alleviated by rest and ice
  • Weakness of flexion and supination
  • Stiffness
  • Tenderness over tendon
  • Can get disuse atrophy if pain has made them stop using limb
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4
Q

Special tests for biceps tendinopathy

A
  • Speed test - proximal biceps tendon
  • Yergasons test - distal
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5
Q

Speed test

A
  • Elbows extended
  • Forearms supinated
  • Forward flex shoulders against examiners resistance
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6
Q

Yergasons test

A
  • Elbows flexed to 90 degrees
  • Forearm pronated
  • Actively supinate against resistance
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7
Q

Investigations biceps tendinopathy

A
  • Clinical diagnosis largely
  • Can do bloods, CRP and plain radiographs to exclude other diagnosis
  • Specialist imaging eg USS and MRI can be used to show thickened (and inflamed for MRI) tendons
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8
Q

Management biceps tendinopathy

A
  • Conservatively
  • NSAIDs for analgesia
  • Ice
  • Physiotherapy
  • USS guided steroid injections can be used if not responsive to initial therapy
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9
Q

Surgery for biceps tendinopathy

A
  • RARE - for decompression
  • Arthroscopic tenodesis (tendon severed and reattached) OR
  • Tenotomy (division of tendon)
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10
Q

Complication of BT

A
  • Rupture of biceps tendon
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11
Q

Biceps tendon rupture - how and what

A
  • Can be complete or partial tear
  • Often occur following sudeen forced extension of flexed elbow (distal)
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12
Q

RF biceps tendon rupture

A
  • Previous biceps tendinopathy
  • Steroid use
  • Smoking
  • CKD
  • Fluoroquinolone abx eg Ciprofloxacin
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13
Q

Clinical features of rupture

A
  • Sudden onset of pain and weakness - flexion at elbow remain due to brachialis and supinator
  • Swelling and bruising
  • Feeling of ‘pop’
  • As proximal belly retracts, can get ‘reverse popeye sign’
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14
Q

Test for distal tendon rupture

A

Hook test
* Elbow flexed at 90 degrees
* Fully supinated
* Examiner attempts to hook index finger underneath lateral edge of biceps tendon - cannot be done if ruptured

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15
Q

Investigations for rupture

A
  • Clinically
  • Confirm via USS
  • Also help surgeon localise distal end of biceps tendon which can retract proximally
  • If USS inconclusive but suspect still - MRI
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16
Q

Management biceps rupture

A
  • Flexion and supination can still occur but weakened - not all cases need surgical management
  • BUT fatigueable and weak muscles = problem
  • For lower demand pts - conservative with analgesia and physio
  • Others - surgery
17
Q

Surgical management biceps rupture

A
  • Anterior single incision OR
  • Dual incision technique
  • Form bone tunnel in radius and reinsert ruptured tendon end
  • Should occur within few weeks of injury otherwise tendon retracts and scars

Antecubital fossa incision or antecubital and posterolateral elbow

18
Q

Complications surgery for biceps rupture

A

Injury to:
* Lateral antebrachial cutaenous nerve
* Posterior interosseous nerve
* Radial nerve (rare)

19
Q

Proximal vs distal biceps rupture

A
  • Proximal of long head more common (glenoid), shoulder pain, popeye sign
  • Distal less common, reverse popeye sign
20
Q
A