close
LOGINLong Head of Biceps Tendon - Part II : The Road to Recovery
In the first part of his article, Chris Mallac took a detailed look at the anatomy and biomechanics of the long head of biceps tendon. In part two, he investigates the appropriate diagnostic tests and imaging modalities, and provides clinician with management protocols.
Athletes involved in sports that require a lot of overhead hand/arm position are vulnerable to long head of biceps tendon (LHBT) pain due to the possible compressive and tensile forces encountered by the tendon within the surrounding bones and soft tissues (as discussed in part one). Therefore, this condition is quite common in swimmers, cross fit athletes, tennis players, gymnasts and Olympic weightlifters just to name a few. Furthermore, the LHBT may also be injured due to strong contractile forces applied by the attached biceps muscle. This would be more common in athletes such as rugby players who are making tackles and throwers such as baseball pitchers.
The main subjective symptoms experienced by those suffering from LHBT pain are as follows:
- Pain is located primarily at the anterior part of the shoulder, often at the bicipital groove, or deep under the acromian process. The cross over of symptoms with subacromial bursitis, rotator cuff pathology and frank labral pathology is very common and often difficult to separate clinically.
- Pain at rest, night pain and pain on rotation are common especially in the event of a tenosynovitis with an inflammatory component.
- The pain may also radiate down the arm and muscle belly, sometimes reaching the radial aspect of the hand, but this usually lacks a precise distribution. It may also co-exist with paraesthesia in this distribution. This would be a differential for a suspected C6 radiculopathy. This is different to the classic ‘deltoid area’ pain suffered by those with supraspinatus pathology.
- A clunk or click may be felt along the bicipital groove with an unstable and subluxing LHBT.
- While the clunk of a subluxing and unstable biceps tendon is classic when the shoulder is rotated (especially in abduction) this clinical sign is uncommon in true dislocations of the LHBT as dislocations are usually irreducible.
| The typical objective clinical signs of LHBT pathology are as follows: |
|---|
| Palpation of the tendon in the groove is usually painful and is best performed with the arm in 10o of internal rotation(1). |
| In dislocations of the LHBT, the tenderness is more medial on the lesser tuberosity, and the tendon can sometimes be rolled under the fingers. |
| Several provocative tests have been described for isolating pathology of the LHBT, but the specificity of these provocative tests is somewhat limited(2-4). These include Yergason’s test and Speed’s test. |
|
The 3-pack test has been described for assessing LHBT pathology(4). This test has excellent inter-rater reliability, sensitivity, and negative predictive value, and is a critical screening tool for LHBT injuries. Hidden extra-articular bicipital tunnel disease can reliably be excluded based on negative tenderness to palpation or a negative O’Brien sign.
The 3-Pack Test consists of:
|
| In the event of a LHBT dislocation, the patient presents with a loss of active elevation above 90o, and it is commonly a limitation in both active and passive external rotation, as the dislocated biceps tendon restrains the inferior part of the subscapularis. |
| The ‘hourglass’ bicep sign can be evaluated by observing active and passive elevation of the arm. There is usually a limitation of the terminal 10o to 20o of active and passive elevation. This corresponds to a true mechanical locking of the shoulder, although there is no loss of rotation. However, this should not be confused with a frozen shoulder(6). |
You need to be logged in to continue reading.
Please register for limited access or take a 30-day risk-free trial of Sports Injury Bulletin to experience the full benefits of a subscription.
TAKE A RISK-FREE TRIAL
Latest Issue
Subscribe Today
Further reading
Newsletter Sign Up
Subscriber Testimonials
Dr. Alexandra Fandetti-Robin, Back & Body Chiropractic
Elspeth Cowell MSCh DpodM SRCh HCPC reg
William Hunter, Nuffield Health
Subscribe Today
Newsletter Sign Up
Coaches Testimonials
Dr. Alexandra Fandetti-Robin, Back & Body Chiropractic
Elspeth Cowell MSCh DpodM SRCh HCPC reg
William Hunter, Nuffield Health
Subscribe Today
Latest Issue
Be at the leading edge of sports injury management
Our international team of qualified experts (see above) spend hours poring over scores of technical journals and medical papers that even the most interested professionals don't have time to read.
For 17 years, we've helped hard-working physiotherapists and sports professionals like you, overwhelmed by the vast amount of new research, bring science to their treatment. Sports Injury Bulletin is the ideal resource for practitioners too busy to cull through all the monthly journals to find meaningful and applicable studies.
*includes 3 coaching manuals
Get Inspired
All the latest techniques and approaches
Sports Injury Bulletin brings together a worldwide panel of experts – including physiotherapists, doctors, researchers and sports scientists. Together we deliver everything you need to help your clients avoid – or recover as quickly as possible from – injuries.
We strip away the scientific jargon and deliver you easy-to-follow training exercises, nutrition tips, psychological strategies and recovery programmes and exercises in plain English.
