Biceps tendonitis, also known as bicipital tendonitis, is the inflammation or irritation of the long head of the biceps tendon, which connects the biceps muscle to the shoulder socket. This condition typically results from overuse or natural degeneration. Diagnosis relies on a comprehensive clinical examination to pinpoint the source of shoulder pain. Specific testing is used to confirm the involvement of the biceps tendon and distinguish it from other common shoulder injuries.
Initial Assessment and History Taking
The diagnostic process begins with a detailed patient interview focused on the nature and location of the pain. Patients frequently report a deep, throbbing ache localized in the anterior, or front, of the shoulder. This pain is commonly aggravated by repetitive overhead activities, which strain the biceps tendon.
Understanding the onset is important; a gradual start suggests degeneration, while an acute onset might point toward a sudden tear. The physical examination starts with palpation over the bicipital groove on the upper arm bone. Tenderness localized precisely in this narrow bony channel, where the long head of the biceps tendon rests, is a significant finding in biceps tendonitis.
Specialized Physical Examination Tests
The next step involves specialized physical maneuvers designed to isolate and stress the long head of the biceps tendon. These provocative tests help confirm the diagnosis and distinguish the pain from other surrounding structures. Two commonly used tests are Speed’s Test and Yergason’s Test, which target the tendon through different mechanical actions.
Speed’s Test
Speed’s Test, sometimes called the Biceps Straight-Arm Test, is performed with the patient’s arm extended straight out in front, palm facing upward. The examiner applies a downward force to the patient’s forearm while the patient attempts to resist this pressure and lift the arm upward. A positive result is the reproduction of pain specifically in the bicipital groove area of the anterior shoulder. This maneuver stresses the biceps tendon and its attachment point, making tendonitis pain apparent.
Yergason’s Test
Yergason’s Test focuses on the biceps tendon’s rotation and stability within its groove. The patient’s elbow is bent to 90 degrees, with the forearm starting in a pronated position (palm facing the body). The patient is instructed to rotate the forearm outward (supination) against the examiner’s resistance. A positive test is indicated by pain in the bicipital groove, suggesting inflammation of the tendon sheath. Alternatively, a noticeable snapping or clicking sensation can indicate the tendon is unstable and popping out of its groove.
Diagnostic Imaging Procedures
While patient history and physical examination provide strong clinical suspicion, imaging is frequently used to confirm the diagnosis or rule out associated injuries. These modalities offer a clearer look at the soft tissues and bony structures of the shoulder.
X-rays
Plain X-rays are typically used at the outset. They are not used to diagnose the tendonitis itself, but rather to exclude bony issues like fractures, arthritis, or bone spurs that could mimic or contribute to the pain.
Ultrasound
Ultrasound is often a preferred initial imaging modality for soft tissue issues like tendonitis. It allows for excellent visualization of the biceps tendon, surrounding fluid, and inflammation. A specific advantage is its ability to be performed dynamically, allowing the clinician to watch the tendon move in real-time to assess for instability or subluxation.
Magnetic Resonance Imaging (MRI)
MRI is a powerful tool used when the physical examination is inconclusive or when other complex issues are suspected. An MRI provides detailed cross-sectional images of the entire shoulder joint. This is superior for assessing the intra-articular portion of the biceps tendon (the part inside the joint capsule). This comprehensive view is helpful for confirming the severity of a tear or ruling out complex problems in the rotator cuff or shoulder labrum.
Understanding the Diagnosis and Related Conditions
A diagnosis of biceps tendonitis is reached by combining the patient’s symptoms, tenderness upon palpation, and positive results on specialized physical tests. It is important to understand that isolated biceps tendonitis is relatively uncommon, occurring in an estimated five percent of patients. The condition frequently presents alongside other shoulder problems, meaning the testing process must differentiate or confirm coexisting issues.
Conditions that commonly mimic or accompany biceps tendonitis include rotator cuff impingement and superior labrum anterior-posterior (SLAP) tears. Impingement involves the compression of the rotator cuff tendons, causing similar anterior shoulder pain. SLAP tears involve the ring of cartilage where the biceps tendon attaches to the shoulder socket, and these tears can also cause pain and a deep clunking sensation.
The full battery of tests, from history to imaging, works together to paint a complete picture. For instance, while Speed’s Test can be positive for both biceps tendonitis and a SLAP tear, localized bicipital groove tenderness and the absence of other specific findings may point toward tendonitis. This layered approach ensures the final diagnosis accurately reflects the underlying pathology, guiding the appropriate next steps for managing the shoulder pain.