Understanding Anterior Shoulder Pain and Biceps Pathology

Long head of biceps (LHB) tendinopathy and associated anterior shoulder pain can develop in patients that increase their lifting load eg moving house, overhead activities, activities that involve loaded shoulder extension and in throwing athletes. Patients may also develop long head of biceps tendon pain after a traumatic ACJ injury or SLAP tear.

How can you identify and treat LHB tendinopathy? In this (video/podcast) with Jo Gibson, you’ll explore:

What causes LHB tendinopathy?

• What mechanisms of injury commonly cause LHB pain, ACJ injury or SLAP tears?
• Key traumas you need to keep an eye out for that impact LHB
• Why do patients with ACJ injuries develop LHB pain?
• Why do patients with SLAP lesions develop LHB pain?
• What causes LHB reactive tendinopathy?

LHB Anatomy & function

• What activities does LHB help with?
• Long head of biceps (LHB) anatomy
• Variance in proximal biceps attachment and how traumatic LHB injuries impact different structures
• How the LHB is stabilised anatomically in the bicipital groove
• Does the transverse ligament exist?

Patient features that help your diagnosis

• Which patients are likely to present with LHB pain?
• Which structures are more likely to be affected with traumatic shoulder injuries in younger vs older patients?
• Why do young patients with LHB instability develop pain?

Subjective history features that help your diagnosis

• Where do patients with LHB tendinopathy experience pain?
• Which movements are likely to be painful in LHB tendinopathy patients?

Objective testing & diagnosis

• Which tests or combinations of tests help diagnose LHB pain?
• Which special tests help your diagnosis?
• Does palpation have any value in LHB diagnosis?
• How can you exclude intra-articular pathology with your testing?
• How can you rule in or rule out rotator cuff pathology?

Rotator cuff tears & involvement in LHB

• How does LHB muscle activity vary in painful vs painfree massive rotator cuff tear patients?
• How do traumatic rotator cuff tears, particularly subscapularis, impact LHB?
• If patients have rotator cuff surgery, what details in the operation notes will help you identify if they are at risk of persistent post-op pain and stiffness?
• Why do subscapularis tears cause LHB pain?

Imaging

• What information does imaging of LHB provide?
• What imaging can you use if your patient is not progressing?
• MRI vs MRA vs US for different pain & injuries

How to treat LHB

• What is the best way to treat LHB tendon pain?
• Are isometrics helpful with LHB, and how do these help?
• What surgery is used for LHB pain?

Additional questions covered

How are results after rotator cuff tears impacted by the rotator interval?

Podcast handout

Free video series “Frozen shoulder assessment & treatment” with Jo Gibson

Shoulder: Steps to Success online course with Jo Gibson

Improve your assessment and treatment of shoulder pain with the Shoulder: Steps to Success online course with Jo Gibson, now available for enrolment at clinicaledge.co/shouldersuccess

Links associated with this episode:

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Articles associated with this episode:

• Download the podcast handout to receive the articles associated with this podcast.

• Creech MJ, Yeung M, Denkers M, Simunovic N, Athwal GS, Ayeni OR. Surgical indications for long head biceps tenodesis: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2016 Jul 1;24(7):2156-66.

• Gilmer BB, Harnden E, Guttmann D. Diagnosis of long head of the biceps tendon pathology: current concepts. Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine. 2017 Jul 1;2(4):222-7.

• Kowalczuk M, Kohut K, Sabzevari S, Naendrup JH, Lin A. Proximal long head biceps rupture: a predictor of rotator cuff pathology. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2018 Apr 1;34(4):1166-70.

• Mehl J. Proximal Biceps Long Head: Anatomy, Biomechanics, Pathology. Operative Techniques in Sports Medicine. 2018 Jun 1;26(2):76-81.

• Wilk KE, Hooks TR. The painful long head of the biceps brachii: nonoperative treatment approaches. Clinics in sports medicine. 2016.