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Biceps Tendinopathy Concept Map, ATRAUMATIC, ANTERIOR SHOULDER PAIN,…
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ATRAUMATIC
SUBJECTIVE INTERVIEW
-Could manifest concordantly subacromial impingement, labrum and rotator cuff pathology
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Nature of Symptoms
-Often described as a deep, throbbing ache
-Can be worse at night if the patient sleeps on the affected side
-Can radiate down arm and into the hand, possibly mimicking radial nerve distribution
-Pt may describe a warming effect where movement may decrease symptoms and increase flexibility. Excessive movement may nullify this effect.
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OBJECTIVE EXAMINATION
Observation
-Forward head rounded shoulder posture is associated with decreased subacromial space
-Scapular dyskinesis is associated with many shoulder pathologies (none in specific) so you might see it here
PLAN OF CARE
Surgical Considerations
-Biceps tenotomy (excision of LHBT)
-Biceps tenodesis (reattachment of LHBT to alternate location)
Functional Tasks
-Reaching, lifting, overhead activity (dishes / home improvement)
-Occupation and/or sport specific activity
(throwing / swimming)
Manual Therapy Techniques
-Mobilization with movement (avoiding pain with GH abduction, flexion, extension and overhead activities in early stages)
-Soft tissue mobilization (biceps, periscapulars)
-Trigger point massage (targeting biceps brachii + rotator cuff muscles)
Progressive Resistance Exercise
(isometrics --> concentric --> eccentric)
-Rotator cuff stretch with dowel (IR/ER)
-Scapular stablizers (scapular pushups)
-Biceps brachii (bicep curls)
Tendon Loading
-Isometric tendon loading
(e.g. Isometric elbow flexion)
-Eccentric tendon loading
(e.g. Eccentric shoulder extension from 100-120deg flexion)
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Modalities
-Dry needling to biceps brachii muscle body (monofilament needle)
-Ice/Heat, other relaxing modalities
Patient Education
-Activity/Occupation/Loading modifications (e.g. avoiding repetitive tasks and full reaching with load)
-Disclose PT treatment plan (to promote patient/provider collaboration)
Muscle Testing
-RI: Strong and Painful OR Weak and Painful with:
-Shoulder flexion
-Elbow flexion
-Forearm supination.
Special Tests
-Combining Speed's test with biceps tendon palpation have decent sensitivity and specificity.
-Upper cut test has limited sensitivity and specificity
-Yergason's and Speed's test both use biceps, but statistics don't support their use for diagnosis of biceps tendinopathy
Palpation
-(-) tenderness of supraspinatus rules out SAI (Sn:0.92)
-(-) tenderness of biceps tendon rules out SAI (Sn: 0.85)
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Vitals signs
HR, BP, SpO2, RR, temperature
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Outcome measures
-Disability of Arm, Shoulder, Hand (DASH), -Upper Extremity Functional Index (UEFI)
Observation
-Visible swelling of anterior shoulder.
-Pt apprehesive to GH AROM flexion, extension.
Screen For Pain Referral
-Cardiovascular system can refer to left shoulder.
-Upper lung neoplasm can refer to ipsilateral shoulder.
Anterior shoulder pain
-Reports of pain with reaching/lifting
-With ADLs and participation in activities related to the GH joint.
High Risk Populations
-Overhead athletes (pitchers)
-Occupations requiring frequent overhead activity (blue flag)
-Individuals with previous LHBT involvement
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Refences
- Beitzel K, Mazzocca AD, Arciero RA. Clinical Anatomy, Biomechanics, Physiologic Function, History, Examination, and Radiographic Evaluation of the Biceps. Operative Techniques in Sports Medicine. 2012;20(3):233-237. Accessed October 26, 2023. https://search-ebscohost-com.ezproxy.library.ewu.edu/login.aspx?direct=true&db=s3h&AN=83166643&site=ehost-live&scope=site
- Chalmers PN, Verma NN. Proximal Biceps in Overhead Athletes. Clinics in Sports Medicine. 2016;35(1):163-179. Accessed November 9, 2023. https://search-ebscohost-com.ezproxy.library.ewu.edu/login.aspx?direct=true&db=s3h&AN=112088748&site=ehost-live&scope=site
- Churgay CA. Diagnosis and treatment of biceps tendinitis and tendinosis. American Family Physician. 2009;80(5):470-476. Accessed October 26, 2023. https://search-ebscohost-com.ezproxy.library.ewu.edu/login.aspx?direct=true&db=cul&AN=105423019&site=ehost-live&scope=site
- Iyer S, Kim HJ. Cervical radiculopathy. Curr Rev Musculoskelet Med. 2016;9(3):272-280. doi:10.1007/s12178-016-9349-4
- Lalehzarian SP, Agarwalla A, Liu JN. Management of proximal biceps tendon pathology. World J Orthop. 2022;13(1):36-57. Published 2022 Jan 18. doi:10.5312/wjo.v13.i1.36
- McDevitt AW, Cleland JA, Addison S, Calderon L, Snodgrass S. Physical Therapy Interventions for the Management of Biceps Tendinopathy: An International Delphi Study. International Journal of Sports Physical Therapy. 2022;17(4):677-694. Accessed October 26, 2023. https://search-ebscohost-com.ezproxy.library.ewu.edu/login.aspx?direct=true&db=s3h&AN=157583508&site=ehost-live&scope=site
- McDevitt AW, Snodgrass SJ, Cleland JA, Leibold MBR, Krause LA, Mintken PE. Treatment of Individuals with Chronic Bicipital Tendinopathy Using Dry Needling, Eccentric-Concentric Exercise and Stretching; a Case Series. Vol 36.; 2020:397-407. doi:10.1080/09593985.2018.1488023
- Reiman, Michael P. Orthopedic Clinical Examination. Human Kinetics; 2016.