Primary long bicipital tenosynovitis
CONSULT TREATMENT PROTOCOL

ANATOMICAL AREAS



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GLOSSARY OF DISEASES

Name Tissue Type of pathologies
Acute and chronic muscle aches and pain Muscle Pain management
Acute and chronic cervical and lumbar pain Muscle Idiopathic cervical and low back pain
Acute and chronic soft tissue wounds Skin Wounds
Adhesive capsulitis Joint Capsulitis
Calcifying tendinitis of the shoulder Tendons Tendinopathy
Cellulite Skin Cellulite
Chronic distal biceps tendinopathy Tendons Tendinopathy
Chronic proximal hamstring tendinopathy Tendons Tendinopathy
Diseases secondary to trigger points and myofascial Pain Muscle Myofascial pain syndrome
Golfer’s elbow Tendons Tendinopathy
Greater trochanteric pain syndrome Tendons Tendinopathy
Insertional Achilles tendinopathy Tendons Tendinopathy
Knee osteoarthritis Joint Osteoarthritis
Medial tibial stress syndrome Tendons Tendinopathy
Mid-body Achilles tendinopathy Tendons Tendinopathy
Osgood-Schlatter disease Bone Disturbance of musculoskeletal development
Patella tip syndrome Tendons Tendinopathy
Plantar fasciopathy Tendons Tendinopathy
Primary and secondary lymphedema Skin Lymphedema
Primary long bicipital tenosynovitis Tendons Tendinitis
Proliferative connective tissue disorders Connective tissue Fibrosis
Spasticity Central nervous system Cerebral palsy and stroke
Stress fractures Bone Fracture
Subacromial pain syndrome Tendons Tendinopathy
Superficial nonunions Bone Fracture
Tennis elbow Tendons Tendinopathy
Trigger points Muscle Myofascial pain syndrome
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MORE INFORMATION

Tenosynovitis of the Long Head of Biceps (LHB) tendon (LHB tenosynovitis) is one of the most common causes of anterior shoulder pain, and is often mistaken for shoulder joint arthritis.

The pathology is fostered by the unique anatomy of the LHB tendon that arises from the supraglenoid tubercle and superior glenoid labrum and slides obliquely through the shoulder joint (glenohumeral joint), arching over the humeral head. The LHB tendon slides upwards during adduction, internal rotation and extension of the shoulder joint, and downwards during abduction, external rotation and flexion of the shoulder joint. As a result, any movement of the shoulder joint may cause irritation of the LHB tendon, potentially resulting in LHB tenosynovitis and severe pain along the LHB tendon.

Ultimately this pain may restrict movement of the shoulder joint, rendering LHB tenosynovitis a major risk factor for developing shoulder adhesive capsulitis. The proximal portion of the LHB tendon is intraarticular but extrasynovial. The synovial sheath of the LHB tendon directly communicates with the glenohumeral joint and ends in a blind pouch located at the distal end of the bicipital groove. Because the LHB tendon and its sheath are adjacent and closely related to each other, both are often affected simultaneously (justifying the term tenosynovitis).

However, the exact cause or result of the lesions has remained controversial. Very recently, it was found that in most cases, anterior shoulder pain attributed to the LHB tendon is not due to an inflammatory process. Rather, pathologic findings of the extra-articular portion of the LHB tendon and synovial sheath appeared to be similar to the pathologic findings in de Quervain tenosynovitis of the wrist, and may be due to a chronic degenerative process similar to this and other tendinopathies (including plantar fasciopathy).

Diagnosis is based on the clinical features of the disease and on imagery (ultrasonography; magnetic resonance imaging).

Conservative treatment comprises injections of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids into the tendon sheath. However, injection of corticosteroids may cause weakening of the tendon. Surgical treatment is conducted only when conservative treatment fails.

CLINICAL EVIDENCE

Liu et al., Ultrasound Med Biol 2012;38:727-735.

Radial extracorporeal pressure pulse therapy for the primary long bicipital tenosynovitis a prospective randomized controlled study.

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TREATMENT PROTOCOL

STANDARD TREATMENT
Number of treatment sessions 3 to 5
Interval between two sessions 1 week
Air pressure Evo Blue® 2 to 4 bar
Air pressure Power+ 1.5 to 3 bar
Impulses 1,500 on the painful spot
Frequency 8Hz to 12Hz
Applicator 15 mm
Skin pressure Moderate to high

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