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Biceps Tendinitis

Biceps tendinitis has been partitioned into primary tendinitis versus secondary tendinitis. Primary tendinitis involves inflammation of the tendon within the bicipital groove. To be considered primary, no other pathological findings (such as impingement, bony abnormalities within the groove, or biceps subluxation) should be present. It is considered an uncommon condition and should be thought of as a diagnosis of exclusion. Habermayer and Walch noted that this diagnosis can only be made during arthroscopy.

Much more common is the condition of secondary biceps tendinitis. As the LHB has an intimate relationship with its adjacent rotator cuff structures—most notably the anterior supraspinatus and superior subscapularis—it is affected by the same forces that produce pathology in these areas.

Although subacromial impingement produces undue forces on the anterior rotator cuff, it also compresses the underlying LHB and produces concomitant pathology (and thereby symptoms) in this structure. In fact, the impingement upon the LHB worsens as a rotator cuff tear progresses and increased contact between the LHB and the coracoacromial arch occurs.

Another potential cause of secondary biceps tendinitis is the presence of bony anomalies of the proximal humerus. Most commonly these bony anomalies are secondary to malunion or nonunion of a proximal humerus fracture. If a fracture extends into the bicipital groove, significant irritation of the LHB can occur.

DePalma and Callery suggested that younger patients with biceps tendinitis are more likely to have groove anomalies such as narrowing or osteophytes, but it is difficult to determine the sequence of events in such conditions.

Do the groove anomalies cause the tendinitis or the tendinitis cause resultant groove anomalies?

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