This page has moved. Click here to view.

Biceps or bicipital tendonitis

The next most common problem in the shoulder is biceps or bicipital tendonitis and you can see in this picture that the biceps tendon actually courses in the joint space initially biceps tendonitis, tendinitis, tendonitus, tendinitus, bicep, shoulder tendinitis. So this is the joint space and the sheath is actually part of the synovial lining. This is very common, repetitive motion biceps tendonitis, tendinitis, tendonitus, tendinitus, bicep, shoulder tendinitis. Many of these tendonopathies are due to repetitive strain. Just like a rope, if you use it too much then it’s going to start fraying and become a problem. One example that I always remember is I went on my honeymoon with my wife and she’s smaller than I am. She has very thin bones, and we had suitcases and we were carrying them around. Within a few days of lugging these suitcases around her shoulder started to bother her. She had classic biceps tendonitis. Well, not that she would have let me stick a needle in her anyway, we were in Europe someplace and you can just buy aspirin and aspirin helped. But that kind of repetitive motion - someone doing some kind of

What patients complain of is pain with this motion; usually contraction of the biceps. Lifting things, raising their forearm up. The other thing that sometimes patients will complain of, and this is a real good clue, is when they are trying to put their jacket on. They put one arm in and when they reach around to put the other arm in, they are putting a stress on the biceps tendon and they say it hurts when they do that. On physical examination, on a thin person, you can actually feel this bicipital groove and sometimes even roll the tendon in your fingers in the groove and it will be tender on examination. If you put a stress on the biceps tendon the patient will complain of pain, and that is just on having them try to "make a muscle", meaning raising their forearm up towards them. Don’t let go, otherwise they will hit themselves in the face and you will have a very angry patient. The other thing I do is have them fully extend their arm with palm up and I just have them push up against my hand. That will also cause pain. That is a little more specific. It’s not as consistent a finding. Again, the range of motion, the shoulder in almost all instances is going to be completely normal, particularly passive range. But also on active range since the biceps muscle doesn’t have anything to do with

Again, treatment: obviously rest. What I did for my wife was I carried the suitcases for as long as I could. It was all her clothes. My suitcase was full of guidebooks so I felt like I was carrying my weight. She wanted to bring an extra suitcase, and I said, "I don’t think so" which was a good thing. Also antiinflammatory drugs work. This is another instance where I think an injection. I will, just like rotator cuff tendonitis, strongly suggest - I never insist, if the patient doesn’t want something there may be a hidden reason why I shouldn’t do it and if they don’t want it, fine - but I’ll suggest to them that this is really going to make you feel better. The risk of rupture is also there, although it is a little bit less since there is less stress on this tendon. You know, local injection of corticosteroids and lidocaine often is very beneficial. Unlike rotator cuff, which does recur in many instances, this is something that generally doesn’t recur. It can if someone is doing a specific activity that is continually going to put a stress on

Adhesive capsulitis, or frozen shoulder, which is more common in people who have underlying arthritis but particularly chronic rotator cuff disease, diabetes. That’s a big one. Diabetics are more prone to frozen shoulder and I think that is the most common reason that I’ve seen it. Occasionally after myocardial infarction patients will get a frozen shoulder. This is different because the patient will complain of pain in their shoulder but it is true shoulder pain. They will localize the pain over the glenohumeral joint, which is basically medial to the head of the humerus. If you examine, that’s where it will be tender. Also they will say, "I have trouble raising my arm up." Their motion is limited and when you examine them you will find that their motion is limited, sometimes such that they can’t even raise their arm up to do their hair or brush their teeth and they are depending on

It’s important to relieve the pain, which can be with antiinflammatory drugs. Sometimes oral corticosteroids, a short course, or intraarticular corticosteroids and get them into physical therapy to get that arm moving, the shoulder moving again. Otherwise, if it’s untreated, you could end up with a very poor functioning joint. If you do all these things, unless the patient is really delayed coming to the doctor, you usually have a pretty good outcome, although it can occur. Reflex sympathetic dystrophy is basically frozen shoulder with distal edema and pain in the hands. Some people think they are essentially the same things, just to

The other thing to keep in mind is that cervical radiculopathy or certain nerve entrapment syndromes can lead to shoulder pain and it’s important to keep these things in mind. The pain is usually neuropathic and the pain expert can certainly tell us that this is generally of a different quality. A strong nocturnal component, burning, numbness, sometimes it feels better if you rub it a little bit. Standard pain medications don’t really work. Also, if there are associated neurologic findings, that’s helpful. Lastly, the range of

In the elbow, several structures can be involved. The first is the olecranon bursa, which is right over the point of your elbow. The most common thing that I see is olecranon bursitis due to trauma. A lot of times they lean on their elbows and about once a month we see a patient in the hospital with olecranon bursitis due to this type of activity. The history may be that the patient doesn’t even know it’s there or they notice that it’s swollen, doesn’t bother them. Sometimes the doctors are more concerned that there is a problem. Although there can be some pain and if it’s just due to trauma, not much warmth or anything else, you have to be concerned that there could be an infection there. Even in a patient with just trauma.