pathology: biceps tendinitis

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biceps tendinitis

Definition of

Usually inflammatory irritation of the long biceps(origin) tendon in the area of the intertubercular sulcus between the two tubercles (major tubercle and minor tubercle) of the humeral head.

A distinction is made between a primary form, which is based on a change in the
Sulcus intertubercularis or the transverse ligament , and a secondary form that arises in the context of other disorders such as rotator cuff lesions or pulley lesions . This causes friction-related damage and subluxations of the long biceps tendon.
If the tendon in the joint is hypertrophied, it can contracts when the biceps for frontal abduction tend to become trapped in the intertubercular groove , which a frontal abduction results in deficit, usually in the order of 10°-20°. Ruptures of the tendon rarely occur in isolation; other structures are usually damaged, it must then for a rotator cuff lesion be examined . Rupture of the tendon leads to Popeye’s sign .

Cause

  1. Usually the result of chronic overuse (lifting or carrying too much weight, inadequate training), or sudden overload
  2. Wear and tear (degeneration due to incorrect loading or overloading, usually from the age of 50) Misalignment of the shoulder joint
  3. tendon-damaging medication (e.g. gyrase inhibitors) and diseases

Predisposing

  1. subacromial impingement syndrome
  2. Frozen shoulder (acute phase)
  3. RA
  4. Cortisone therapy
  5. Frequent overhead work
  6. Sports that put strain on the shoulder joint such as javelin throwing
  7. (similar factors to SLAP lesion)
  8. Damage to the pulley complex (pulley laesion)

Diagnosis

  1. Sono shows thickening and fluid accumulation (edema) around the distended primordial tendon of the biceps , caput longum .
    If the tendon lies partially on the edge of the intertubercular groove or is dislocated , a pulley lesion or a tear in the subscapularis tendon must be examined. will be found sonographically If there is a complete rupture, an interruption of continuity or even an empty intertubercular sulcus .
  2. X-rays may show calcification of the tendon, an interruption of the calcification pathway indicates a tendon rupture
  3. MRI
  4. Palpatory tenderness and possibly swelling over the intertubercular sulcus
  5. Tests and signs: Speed test, Palm up test

Symptoms

  1. Dull to sometimes stabbing pain in the ventral humerus, more deeply localized during frontal abduction, lateral abduction, retroversion and also internal rotation, as well as subordinately during flexion of the elbow joint, which runs along the course of the tendon of origin of the long head of the biceps. Brenen’s is also described.
  2. Pain may radiate in the direction of the forearm
  3. Pain-related restriction of strength Tension pain, pressure pain in or over the affected tendon
  4. Rarer: jumping, snapping, cracking

Therapy

  1. Treatment is usually conservative; in mild cases, healing can take place in 5 – 14 days with consistent rest, but can also take weeks to months.
  2. in the secondary form: treatment of the causes, which often means training the rotator cuff and the trunkoscapular muscles
  3. Anti-inflammatory drugs, iontophoresis
  4. Infiltrations (Traumeel/Zeel)
  5. Autologous conditioned plasma
  6. Physical therapy: ultrasound, cryotherapy, shock wave therapy
  7. Osteopathy
  8. Stretching training
  9. PT: transverse friction, longitudinal friction, taping
  10. If the cause is overuse: load reduction
  11. Tenotomy with fixation in the sulcus or suture anchor (tenodesis) for structurally severely damaged tendons, then early functional rehabilitation
  12. Sports that strain the arm only after healing

DD

  1. Impingement syndrome of the shoulder (subacromial impingement)

Complications

  1. Tendency to chronification
  2. Over time, the structure of the biceps tendon can be weakened to such an extent that the tendon ruptures. The tendon rupture can become noticeable primarily through a reduction in pain, rather than a loss of strength, as the long tendon only bears approx. 10-15% of the load compared to the short tendon. Then the Popeye sign appears, a distally displaced long head. A distal tendon rupture would show the reverse Popeye sign (both heads displaced proximally).
  3. A torn long biceps(origin) tendon is considered not to be sutured or refixed.

Asana practice and movement therapy

The first important measure is to reduce strain. Heavy carrying and lifting as well as heavy frontal abductions are contraindicated in the acute inflammatory phase, as is immobilization of the shoulder joint. Movements may not be pain-free, but – especially in the case of the shoulder joint – flexibility must be maintained and cartilage lubrication ensured. In principle, the level of tension and flexibility of the biceps should be checked. Stretching the biceps can also make a significant contribution to relieving the tendon. Muscular imbalances in the shoulder area must be addressed. It is not uncommon for the dorsal muscles of the shoulder joint to lack strength. The improved straightening of the rib cage should also have a positive influence, i.e. a reduced tendency to hyperkyphosis of the thoracic spine as well as a reduced tendency to protraction of the shoulder blades.

Asanas