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Which specific maneuvers can reproduce the pain of bicipital tendinitis? Maneuvers that resist the normal function of the biceps —supination and flexion of the forearm: Yergason’s test: The hand is pronated, the elbow flexed to 90 degrees, and the shoulder in adduction (i.e., arm against the body). With the patient attempting supination of the forearm (i.e., palm up), you resist with one hand while with the other you press on the bicipital tendon. The test is positive when it elicits pain and tenderness over the bicipital groove. Speed’s test: Dr. Speed actually never described this maneuver. It was first reported by Crenshaw and Kilgore in 1966, quoting “personal communication” as their source. It is performed by having the patient attempt to flex the affected arm against resistance, after positioning it with elbow extended and forearm in supination (i.e., palm up). Once again, you resist with one hand while you press with the other on the bicipital tendon. The test is positive when it elicits pain over the bicipital groove. As validated by arthroscopy, it has a 14% specificity, 90% sensitivity, 23% positive predictive value, and 83% negative predictive value. What are the symptoms/findings of bicipital tendinitis?
Achy anterior shoulder pain, worsened by overhead activity, lifting of heavy objects, and elevated pushing/pulling. Rest is usually beneficial, whereas flexion of the elbow against resistance is detrimental. Pain is vague, though at times it may become localized to the anterior humerus. On exam, there is point tenderness over the bicipital groove, which is the area where the long tendon is anatomically exposed. This lies 3 inches below the anterior acromion and may be best localized by holding the arm in 10 degrees of external rotation. Pain also can be elicited by passive abduction of the arm in a painful arc maneuver ,which is typical of impingement syndrome, although at times it also may be positive in patients with isolated biceps tendinitis. What is bicipital (or biceps) tendinitis?
Inflammation of the long head tendon. This can be sudden (from a direct injury) or gradual. The latter is usually the result of shoulder overuse and thus typical of “overhead” athletes: baseball pitchers, racquet players, swimmers, and rowers/kayakers. As the arm is passed into excessive abduction and external rotation, the long head tendon suffers repetitive injury and eventual wear-and-tear. Most commonly, though, the tendon becomes inflamed because of other shoulder problems, such as rotator cuff disease, impingement, instability, or labral tears. What is AC separation?
A disruption of the AC joint, usually traumatic. When compared to the unaffected side, the area is swollen, deformed, and painful upon compression or stress maneuvers (such as moving the arm across the chest). In fact, the patient usually keeps the arm very still. What is acromioclavicular (AC) arthritis? How do you diagnose it? It is arthritis of the AC joint, a structure that is minimally mobile but still prone to inflammation. This, in turn, may lead to rotator cuff irritation through the downward protrusion of bony spurs into the tendon. Pain of AC arthritis is initially vague, localized to the joint, and possibly radiated to the shoulder, anterior chest, and neck. With time, it may become associated with crepitus and swelling. Pain can be elicited by direct compression of the joint, or by stress maneuvers. These involve (1) cross-body adduction of the arm behind the back (which produces pain in the AC joint at the end of adduction); (2) movement of the arm across the chest (so that the hand touches the opposite shoulder); and (3) cross-arm maneuver (the arm is forward flexed and then adducted across the body). These tests are positive when they elicit pain in the AC joint. What is shoulder synovitis? How do you diagnose it?
Shoulder synovitis is inflammation of the joint. Diagnosis is made by detecting “fullness” just below the clavicle, medial to the deltoid, and clearly visible when compared to the other side. On palpation, there is “bogginess” over the anterior surface of the joint, coinciding with the fullness. In addition to history, how else do you identify referred shoulder pain?
By its being typically nondescript, poorly localized, and not reproducible on shoulder exam. here to edit.
What are the origins of referred shoulder pain?
Various. Shoulder (or scapular) pain can originate from many internal organs, including the myocardium (angina and infarction), hepatobiliary system (cholecystitis), and diaphragm (subphrenic abscess). It also may originate from cervical spine and neurovascular entrapment. For example, burning and tingling in the deltoid area may result from irritation of nerve roots, especially C5 and C6. Hence, any patients with shoulder pain who also have C-spine symptoms should have a brief neck exam (with and without resistance) to exclude referred disease. |