Biceps tendinopathy and tendon rupture
- Stephen M Simons, MD, FACSM
Stephen M Simons, MD, FACSM
- South Bend-Notre Dame Sports Medicine Fellowship
- J Bryan Dixon, MD
J Bryan Dixon, MD
- Clinical Assistant Professor of Family Medicine
- Michigan State University College of Human Medicine
- Medical Director
- United States Olympic Education Center
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Shoulder pain is a common presenting complaint to primary care offices and sports medicine clinics. The basic workup for shoulder pain should include assessment of the biceps tendon, which has been considered a common cause of shoulder pain since the 1930s [1,2].
Biceps tendon injuries include a spectrum of disorders ranging from mild tendinopathy to complete tendon rupture. Rupture occurs most frequently at the long head of the proximal tendon, but may occur in the distal tendon. Coexistent injuries at the biceps tendon origin and superior glenoid labrum constitute a variety of disorder known as SLAP (superior labrum, anterior to posterior) lesions . SLAP lesions are reviewed separately. (See "Superior labrum anterior posterior (SLAP) tears".)
This topic review will discuss the presentation and management of biceps tendinopathy (primarily of the proximal long head of the biceps tendon) and biceps tendon rupture, both proximal and distal. The general evaluation of shoulder complaints in adults and other discrete causes of shoulder pain and dysfunction are reviewed separately. (See "Evaluation of the patient with shoulder complaints" and "Physical examination of the shoulder" and "Rotator cuff tendinopathy" and "Presentation and diagnosis of rotator cuff tears" and "Glenohumeral osteoarthritis" and "Overview of upper extremity peripheral nerve syndromes", section on 'Proximal neuropathies'.)
EPIDEMIOLOGY AND RISK FACTORS
Data describing the incidence of biceps tendon injury by sport or occupation is scant and should be interpreted cautiously. Such injuries appear to occur more often among those who engage in frequent pulling, lifting, reaching, or throwing for work or recreation. Two clinical series describe biceps tendon ruptures in rock climbers and weight lifters [4,5].
Degenerative tendinosis and biceps tendon rupture are usually seen in older patients, while isolated tendonitis usually presents in the young or middle aged . According to a single-center study from the United Kingdom, among older patients (seventh decade of life) biceps tendon ruptures occurred at a rate of 0.53/100,000 over five years, with a male to female ratio of 3:1 . This study did not distinguish among proximal and distal biceps tendon injuries. Based on clinical experience, proximal biceps tendon injuries are far more common.
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- EPIDEMIOLOGY AND RISK FACTORS
- CLINICAL ANATOMY
- MECHANISM OF INJURY
- CLINICAL PRESENTATION
- PHYSICAL EXAMINATION
- General approach and overview
- Long head (proximal) biceps tendon evaluation
- - Inspection and palpation
- - Special tests
- Distal biceps tendon evaluation
- - General examination
- - Special tests
- DIAGNOSTIC IMAGING
- Approach to imaging
- Additional ultrasound resources
- Plain radiographs
- Magnetic resonance imaging
- DIFFERENTIAL DIAGNOSIS
- Long head biceps tendon (anterior shoulder pain)
- Distal biceps tendon (anterior elbow pain)
- INDICATIONS FOR ORTHOPEDIC REFERRAL
- Proximal biceps tendon injury
- Distal biceps tendon injury
- INITIAL TREATMENT
- Glucocorticoid injection for tendinopathy
- FOLLOW-UP CARE
- Long head (proximal) biceps tendinopathy
- Proximal long biceps tendon tear initially managed nonsurgically
- Distal biceps tendon tear
- RETURN TO SPORT OR WORK
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS