Join Jo Gibson, a clinical physiotherapy specialist at the Liverpool Upper Limb Unit, as she unpacks the intricacies of anterior shoulder pain related to the long head of biceps (LHB) and SLAP tears. She dives into the common mechanisms of injury and how activities like lifting and throwing can cause LHB tendinopathy. Jo also highlights innovative diagnosis techniques such as the 'three-pack examination' and ultrasound, alongside discussing effective treatment options like tenodesis and tenotomy. A must-listen for physiotherapists!
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LHB Anatomy
The long head of biceps (LHB) originates at the supraglenoid tubercle and superior labrum, with variations in attachment.
Its stability in the bicipital groove depends on structures like the coracohumeral ligament and surrounding muscles.
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LHB Pathology
LHB tendinopathy is rarely a primary pathology, often indicating underlying issues like rotator cuff problems or instability.
In massive rotator cuff tears, symptomatic patients use their biceps less than those with good function.
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LHB Conditions
Degenerative pathology, overload, and reactive tendinopathy are common LHB issues, often secondary to instability or overhead work.
Traumatic tears, particularly affecting supraspinatus or subscapularis, can destabilize the biceps and cause symptoms.
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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
Physio Edge podcast with David Pope