Accuracy of long head of the biceps tendon palpation by physical therapists; an ultrasonographic study

[Purpose] Examination and treatment of the long head of the biceps tendon (LHBT) requires accurate palpation. The purpose of this study was to determine physical therapists’ reliability and ability to accurately palpate the LHBT in two arm positions with ultrasound as the gold standard. [Participants and Methods] Examiners palpated the LHBT within the intertubercular groove (ITG) of the humerus on the bilateral shoulders of 32 asymptomatic (21 female; 24.3 ± 1.9 years) participants in 2 arm positions. The magnitude of distance between a marker and the border of the ITG was compared between 2 positions using an independent t-test. Percent accuracy was calculated. [Results] Inter-rater reliability was poor (position 1, k=1.04; position 2, k=0.016). Overall accuracy rate was 45.7% (117/256). Accuracy was 49.2% (63/128) and 42.2% (54/128) for testing position 1 and position 2 respectively. Mean distance palpated from the groove was M=2.58 mm (± 6.2 mm) for position 1 and M=3.77 mm (± 6.6 mm) for position 2. Inaccurate palpation occurred medially 72.3% (47/65) and 93.2% (69/74) in position 1 and position 2 respectively. [Conclusion] Results of this study did not support one arm position being more accurate over another for LHBT palpation.

[1]  S. Wisniewski,et al.  Can Ultrasound Be Used to Improve the Palpation Skills of Physicians in Training? A Prospective Study , 2018, PM & R : the journal of injury, function, and rehabilitation.

[2]  Jonathan Flug,et al.  Arthrographic Anatomy of the Biceps Tendon Sheath: Potential Implications for Selective Injection. , 2017, Current problems in diagnostic radiology.

[3]  A. Malmivaara,et al.  Finnish Subacromial Impingement Arthroscopy Controlled Trial (FIMPACT): a protocol for a randomised trial comparing arthroscopic subacromial decompression and diagnostic arthroscopy (placebo control), with an exercise therapy control, in the treatment of shoulder impingement syndrome , 2017, BMJ Open.

[4]  A. Yang,et al.  Resident Accuracy of Joint Line Palpation Using Ultrasound Verification , 2014, PM & R : the journal of injury, function, and rehabilitation.

[5]  S. Henry,et al.  Ultrasound Measures of the Lumbar Multifidus: Effect of Task and Transducer Position on Reliability , 2011, PM & R : the journal of injury, function, and rehabilitation.

[6]  P. Papadopoulos,et al.  Long Head of the Biceps Pathology Combined with Rotator Cuff Tears , 2012, Advances in orthopedics.

[7]  Jay Smith,et al.  Accuracy of Palpating the Long Head of the Biceps Tendon: An Ultrasonographic Study , 2011, PM & R : the journal of injury, function, and rehabilitation.

[8]  Jay Smith,et al.  Accuracy of Ultrasound‐Guided and Palpation‐Guided Knee Injections By an Experienced and Less‐Experienced Injector Using a Superolateral Approach: A Cadaveric Study , 2011, PM & R : the journal of injury, function, and rehabilitation.

[9]  M. Provencher,et al.  Long Head of the Biceps Tendinopathy: Diagnosis and Management , 2010, The Journal of the American Academy of Orthopaedic Surgeons.

[10]  Jay Smith,et al.  Accuracy of Ultrasound‐Guided Versus Palpation‐Guided Acromioclavicular Joint Injections: A Cadaveric Study , 2010, PM & R : the journal of injury, function, and rehabilitation.

[11]  S. Carmichael,et al.  Ultrasound‐guided versus Nonguided Tibiotalar Joint and Sinus Tarsi Injections: A Cadaveric Study , 2010, PM & R : the journal of injury, function, and rehabilitation.

[12]  X. Jia,et al.  Clinical and diagnostic tests for shoulder disorders: a critical review , 2009, British Journal of Sports Medicine.

[13]  Mark A Kevern,et al.  Long head of the biceps tendon pain: differential diagnosis and treatment. , 2009, The Journal of orthopaedic and sports physical therapy.

[14]  Amit Aurora,et al.  Commercially available extracellular matrix materials for rotator cuff repairs: state of the art and future trends. , 2007, Journal of shoulder and elbow surgery.

[15]  P Boileau,et al.  The long head of biceps and associated tendinopathy. , 2007, The Journal of bone and joint surgery. British volume.

[16]  Harpreet S Gill,et al.  Physical Examination for Partial Tears of the Biceps Tendon , 2007, The American journal of sports medicine.

[17]  L. Bouter,et al.  Costs of shoulder pain in primary care consulters: a prospective cohort study in The Netherlands , 2006, BMC musculoskeletal disorders.

[18]  B. Koes,et al.  Incidence and prevalence of upper-extremity musculoskeletal disorders. A systematic appraisal of the literature , 2006, BMC musculoskeletal disorders.

[19]  T. Stitik,et al.  Persistent shoulder pain: epidemiology, pathophysiology, and diagnosis. , 2005, American journal of orthopedics.

[20]  H. Razmjou,et al.  Accuracy of the Speed's and Yergason's tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. , 2004, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[21]  A Burdorf,et al.  Prevalence and incidence of shoulder pain in the general population; a systematic review , 2004, Scandinavian journal of rheumatology.

[22]  John McMullen,et al.  Qualitative clinical evaluation of scapular dysfunction: a reliability study. , 2002, Journal of shoulder and elbow surgery.

[23]  A. Murthi,et al.  The incidence of pathologic changes of the long head of the biceps tendon. , 2000, Journal of shoulder and elbow surgery.

[24]  G. Deyle,et al.  Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. , 2000, The Journal of orthopaedic and sports physical therapy.

[25]  H. Refior,et al.  The role of the bicipital groove in tendopathy of the long biceps tendon. , 1999, Journal of shoulder and elbow surgery.

[26]  J. Arendzen,et al.  The long-term course of shoulder complaints: a prospective study in general practice. , 1999, Rheumatology.

[27]  S. Keinänen-Kiukaanniemi,et al.  Patients with neck and shoulder complaints and multisite musculoskeletal symptoms--a prospective study. , 1997, The Journal of rheumatology.

[28]  A. Silman,et al.  The clinical course of shoulder pain: prospective cohort study in primary care , 1996, BMJ.

[29]  L. Bouter,et al.  Complications of spinal manipulation: a comprehensive review of the literature. , 1996, The Journal of family practice.

[30]  Optimal methods for shoulder tendon palpation: a cadaver study. , 1996, Physical therapy.

[31]  P. Paavolainen,et al.  Radiographic diagnosis of biceps tendinitis. , 1985, Acta orthopaedica Scandinavica.

[32]  W. Reinus,et al.  Ultrasonography of the rotator cuff: technique and normal anatomy. , 1984, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[33]  E. L. Gilcreest DISLOCATION AND ELONGATION OF THE LONG HEAD OF THE BICEPS BRACHII , 1936, Annals of surgery.