Possible biceps tendonitis (shoulder)?

[Sarah20]

Hi everyone,
I need help diagnosing a particular patient. She used to be a competitive swimmer but took some time off to have children. She began swimming again but in the first week noticed some pain in her right shoulder, on the anterior aspect of the head of the humerus. she continued swimming but the pain gradually got worse as time progressed. she says the pain went away when she showered but that she has a dull achy pain most of time and a sharp pain when she reaches back, or overhead. she hasn't had any injuries before.

So my first thought was bicipital tendonitis, but can anyone please tell me how I would test for this? For example, what actions (flexion, extension, etc..) can I test and where can I expect pain within the range of motion?

Thanks everyone! help is MUCH appreciated

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[msk101]

Hi,
As a swimmer i know the feeling! I would check for impingement of the Sub Acromial bursa and ask her to show you her freestyle stroke technique. see if she internally rotates and adducts at the hand entry into the water as this will impinge the bursa. I would suggest asking her to widen her hand entry slightly and flat hand entry rather than thumb down to see if that eases the discomfort during swimming. Also would be good to see her stroke in general as if she isn't getting enough body roll then the arm adducts and horizontally flexes during catch and pull which will also impinge the bursa.
Tests for impingement that are really quick and easy are Neer cans, and the Hawkins tests.
palpation during stroke replication should confirm if that is in fact the problem. NSAIDs for a few days and easing back into swimming with concentration on stroke rather than full on speed and distance should also help.

Let us know how you go!

msk101

[linbin]

hi friend
i am not sure how well you could do structural differentiation in shoulder especially in impingement.
what the recent studies suggests it as "subacromial impingement syndrome"
you can do a cluster of tests and clinical signs .....
pain in subacrmial area with palpation
pain ful arc sign
full can test
neer impingement test
speed test
hawkins kennedy test

also we can approach it based on movement impairment syndrome concept.analyse the movements and functional activities
keeping in mind....post partum related changes

[pudding_bowl]

Hi sarah
Special tests for biceps are speed's test and yergasons test - they'll be easy enough to find online or in brukner and kahn. try them and take them on board with other tests. our 'special tests' are never as specific or as accurate as we'd like them to be.
Definately a good idea to check her technique with swimming - or it may be that she needs to slow it down and build up her stength again before returning to swimming (this is assuming she tried to return to pre levels of activity too quickly). Let us know how you get on.

[aprillove20]

Ignorance is dangerous, but knowledge without responsibility is more dangerous.

[ginger]

"Ignorance is dangerous, but knowledge without responsibility is more dangerous"

that is precious.
Think I'll put that on the wall
Kinda goes with
"No swimming in the crocodile enclosure "
or
"to do is to be, to be is to do, do be do be doooooo"