Chapter 4 - Taylor Severide: A 32-Year-Old Male With Severe Right Shoulder Pain With an Associated Catching Sensation

Abstract

The pain of bicipital tendinitis is constant and severe and is localized in the anterior shoulder over the bicipital groove. A catching sensation may accompany the pain. Significant sleep disturbance is often reported. The patient may attempt to splint the inflamed tendons by internal rotation of the humerus, which moves the biceps tendon from beneath the coracoacromial arch. Patients with bicipital tendinitis have a positive Yergason test. The tendons of the long and short heads of the biceps are particularly susceptible to the development of tendinitis. Bicipital tendinitis is usually caused at least partially by impingement on the tendons of the biceps at the coracoacromial arch. The onset of bicipital tendinitis is generally acute, occurring after overuse or misuse of the shoulder joint, such as trying to start a recalcitrant lawn mower, practicing an overhead tennis serve, or performing an overaggressive follow-through when driving golf balls. The biceps muscle and tendons are susceptible to trauma and to wear and tear. If the damage is severe enough, the tendon of the long head of the biceps can rupture, leaving the patient with a telltale Popeye biceps (named after the cartoon character). This deformity can be accentuated by having the patient perform the Ludington maneuver: placing both hands behind the head and flexing the biceps muscle.