Biceps tendon tenosynovitis - a sonologic marker of shoulder joint derangement

Abstract

Objectives: To study biceps tendon sheath fluid collection using musculoskeletal ultrasound and evaluate its cause. Materials and Methods: A total of 15 patients with biceps tendon sheath fluid collection were studied. All these patients presented with history of shoulder pain with inability of overhead abduction of arm and painful circumduction. Discussion: Ten had history of trauma, four had acute trauma and six had an old history of trauma. Five had degenerative shoulder joint disease, out of these two had osteoarthritis and three had rheumatoid arthritis with subacromiodeltoid bursitis. All cases were evaluated on B mode high frequency ultrasound. The gray scale findings were correlated with clinical and arthroscopic findings. These patients were treated conservatively and followed up sequentially. Results: Diagnosis of tendonitis prompted us for a detailed joint examination which revealed rotator cuff tear in eight patients, these tears varied from acute to chronic and partial to complete thickness tears. Five patients had arthritis, two had osteoarthritis with erosion and pitting of the bony groove and three had bursitis secondary to rheumatoid arthritis with tendonitis. Conclusion: The utility of high frequency ultrasound as an imaging technique for biceps tendon is a useful adjunct to clinical examination. The procedure is non invasive, safe without risk of exposure to harmful radiation, cost effective, dynamic and a useful aid in diagnosis. The diagnosis of biceps tendon sheath fluid must prompt a musculoskeletal sonologist for a detailed evaluation of the shoulder.