Biceps tendon and Rx?

[Njorl]

Hi Fellow Physio's,

I am wondering for some advice for a lady that I seen in clinic today.

35 years ole fit and healthy regular gym user. Desribed pain down lateral left upper arm from shouler tip to just above elbow, desribes pain as sharp with movement and sometimes absent at rest though it can ache if done lots of aggravating activities. Onset 4 weeks ago, question as to onset and cannot think of anything different in her life that could have contributed. Reports hurts putting coat on, hurts changing gear in car, hurts even to push a button. Has quite a physical job as an engineer fixing hosp machinery.

Wanted to rule out neck so tested and she had full pain free movement and no Hx of neck probs. There was tightness left upper traps with side flex to right.

A history of LBP that the lady says completely gone through her trans abs contract when running.

Full pain free mvt of unaffected right arm and shoulder.

Symptomatic left shoulder at 90 degrees shoulder flex gets pain but can go further to get pain free and achive FROM.

Ext at shoulder reports no pain. Hand behind head can manage but not push elbow back due to pain.

Full muscle power resist bicep, tricep tested with elbow tucked into waist. Lat rotation causes sig pain, nil with resist medial rotation.

Special tests: full can empty can produces pain

Palpation of aromion and around is tender to touch and some pain in pec Major/minor.

On further questionning we established that she had begun a routine of bicep curls using weights in the gym around 4 wks ago.

My thoughts are that there is damage to the biceps tendon or transverse lgt.
What is the time frame for healing in this and does this sound like a correct diagnosis?The Pt then had her arm aching after all the tests.

I massages the region within tolerance and applied US. I gave her some stretching exercises but very gentle ones.

Are there any good treatments for this injury or exercises? what are the prognosis in these injurys and what should be avoided?

Hope someone can advise, thanks Njorl

[linbin]

hi friend
check any greater tuberosity tenderness
neer impingement test
kennedy hawkins test
yergenson's test
speed test
crank test

my differential diagnosis
-impingement syndrome
-anterior shoulder instability
supraspinatus tendinitis
biceps tendinitis

how's her posture
scapular position,
joint play

[Njorl]

Hey guru in the making,

Thanks for reply, I will apply those tests next apt and see if my Rx made any difference.

From memory there was a neck crease c3/c4 level and thoracic looked a bit more kyphotic than normal. Perhaps she is over strong in some muscles from her workouts and weak in others.

Thanks again, Njorl

[abhidoc]

i want to discuss some quarries about cervical headache and vrtigo, being a physio i am applying traction and upper cervical glides, occipital headaches can also be redused by stretching trepizius, what else can be performed,

[linbin]

hi buddy
tension head ache will help with glides in the upper cervical-check out maitland's recent edition for various glides which are helpful
deep cervical neck flexor strenghtening should be given importance as it is the core muscle .
stretching of the tight muscles and strengthening of weak muscles in short.check out janda's upper cross syndrome and management techniques
cheers

[abhidoc]

thanks for the advice , i will follow such advice and report u later , although i was following almost the same strategy

[jesspt]

Definately seems like sub-acromial impingement syndrome.

[jwilso]

sounds like classic subacromial impingement with involvement of supraspinatus. i cant work out why you have gone down the biceps route as nothing in your assessment points to a biceps problem. you may have been misled in the fact that they were doing bicep curls prior to the onset of the problem.

[sports therapy]

Hi i am a 3rd year sports therapy student and i have a 20 year old male that does recreational kayaking. He is complaining of a twinging pain around the corocoid process and a sharp pain down the medial aspect of his arm following a role in a kayak.

I have carried out an assessment and have come to the conclusion he has a tear in the short head of the biceps tendon; during the ludingtons test palpation was painful and the tendon was more apparent on the injured side.

The patient is fairly slender and does not have much muscle bulk around the upper body; i am wanting to do strengthening exercises but am unsure of what to do as i do not want to irritate.
I am considering also frictions to reduce pain- could anyone advice me?

Thanks

[KiwiDPT]

I would do the special test Yergasons to check long head of bicep involvement, you could also check the integrity of the transverse humeral ligament with ER with palpation to see if the tendon rolls out.
If these are clear then likely it is the supra as suggested above.
After the acute phase, treated with positioning and modalities, I dive into eccentrics. Research has shown them to be effective with tendonopathies.