Biceps Tendon Evaluation, Injection Ultrasound - Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing the techniques of ultrasound guided injection of the biceps tendon.
The biceps tendon is a common cause of pain in front of the shoulder. The pain associated with the biceps tendon is usually due to biceps tendonitis.
Diagnosis
•Localized tenderness in the groove
•Speed test
Clinical evaluation of biceps tendonitis
Speed test
•The patient is asked to actively forward flex the shoulder while the examiner is applying resistance to the movement.
•Tenderness over the bicipital groove indicates tendinitis of the long head of the biceps.
Examining the biceps tendon
•Patient position: the patient should be sitting upright with the arm beside the body. The elbow is flexed to 90 degrees and the hand in supination resting on the thigh.
•Apply the probe over the anterior part of the shoulder to identify the biceps tendon.
•The biceps tendon is located within the bicipital groove. It appears as an oval structure in the groove with minimal fluid surrounding it.
•On the medial side you will find the subscapularis tendon. The subscapularis tendon will be inserted into the lesser tuberosity at the medial side of the groove.
•On the lateral side you will find the supraspinatus tendon. The supraspinatus tendon will be inserted into the greater tuberosity on the lateral side of the groove.
•Usually the examiner will place the probe over the bicipital groove to identify the biceps tendon between the subscapularis and the supraspinatus tendon.
•Rotate the probe 90 degrees to the longitudinal position and move it upwards to examine the intra-articular portion of the biceps in order to identify any SLAP lesion.
•Then move the probe distally along the humerus in order to examine the tendon up till the myotendinous junction at the pectoralis muscle insertion.
•Move the elbow in flexion and extension in order to see the movement of the biceps tendon within the groove.
Abnormal conditions which may appear on ultrasound:
•Fluid around the tendon
•Hyperemia as shown on Doppler.
•Tendinopathy (tendinitis): biceps tendon is enlarged, rounded and there will be fluid around the tendon. Occurs from overuse and microtrauma.
•Tears of the biceps tendon
•Biceps tendon instability or subluxation: medial subluxation of the biceps tendon may be associated with subscapularis tear. movement of the biceps tendon within the groove may be accompanied by a click sound. If the fluid is in the biceps sheath and within the subacromial bursa, then there is a rotator cuff tear in about 95% of the patients.
Technique for injection
•Probe is placed in a transverse orientation over the bicipital groove.
•Injection of the biceps tendon is usually given from the lateral side.
•When feasible, ultrasound-guided injection is more precise than blind injection.
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@nibraham thanks

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Thank you for your support! Spread the word

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@whatsup149 THANKS

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@orthopassion THANKS

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[@WarBorn313]

Had this done about a week and a half ago. This is the worst my shoulders been since I injured it the first time. I'm definitely not doing this again.

[@guillermoparedes6450]

Did the shot help you at all?

[@TheForbinator]

Excellent video! Especially in regards to understanding ultrasound examination of the biceps tendon. Thank you!

[@marcdautricourt4477]

this video very helpful to me

[@romancelikovsky6916]

Super....

[@drgadham]

Very good demo 👍

[@TheMollyEbraheim]

Great video!

[@nibraham]

Great Video

[@drsiliverurajesh]

fanatstic video sir.

[@mamdouhhaddara5297]

Excellent video