Snapshot A 21-year-old man presents to the sports clinic for the evaluation of right-sided anterior shoulder pain that radiates to the biceps. The pain worsens when he pulls or lifts heavy objects and is also bothersome during the night. He plays football for his university where he trains approximately 5 times a week. On physical exam, there is tenderness of the right bicipital groove and a positive Speed's and Yergason's test. Introduction Clinical definition describes biceps tendon pain and tenderness Epidemiology Incidence exact frequency is unknown Demographics athletes 18-35 years of age Location often the long head biceps tendon (LHBT) can occur in the distal biceps tendon Risk factors patients who frequently pull, lift, reach, or throw are at risk Etiology Pathophysiology pathoantomy there are a number of possible causes login to view 4 more bullets Associated conditions shoulder pathology (e.g., issues with the rotator cuff and scapular stabilizers) Presentation Symptoms anterior shoulder pain with distal radiation over the biceps muscle (classic) pain worsens with lifting, pulling, or performing repetitive overhead activities Physical exam bicipital groove tenderness upon palpation of the LHBT point tenderness of the biceps tendon has been regarded as pathognomonic for injury of the biceps tendon Speed's test maneuver login to view 2 more bullets positive result login to view 1 more bullet Yergason's test maneuver login to view 2 more bullets positive result login to view 1 more bullet Imaging Radiographs indications to evaluate for bony causes of impingement to rule out other causes of shoulder pain Ultrasound indications can be useful is assessing for bicep rupture, subluxation, and dislocation MRI indications if there is no improvement of symptoms after treatment or if the diagnosis is unclear can be considered when there is a need to also evaluate for shoulder pathology surgical planning Studies Diagnostic criteria this is a clinical diagnosis Differential Rotatory cuff pathology Glenohumeral osteoarthritis Adhesive capsulitis ("frozen shoulder") Cervical disk disease Treatment Conservative rest and activity modification indication login to view 1 more bullet physical therapy indication login to view 1 more bullet Medical NSAIDs indication login to view 1 more bullet Ultrasound-guided glucocorticoid injections indication login to view 1 more bullet Complications Biceps tendon rupture patients can present with a "popeye" sign Prognosis Patients can fully recover within 6-8 weeks with proper management