Issue link: https://www.massageandbodyworkdigital.com/i/1128556
that motion, which may also reproduce the client's pain. In some cases, pain is felt at the far end of medial or lateral rotation as the tendon is pulled against the sides of the bicipital groove. Resisted isometric contractions of shoulder fl exion, elbow fl exion, or supination may also cause pain. Speed's test is a special orthopedic test that is a modifi cation of a simple manual resistive test. For this procedure, the shoulder is fl exed to about 90 degrees, and the elbow is fully extended while the forearm is held in supination. The therapist exerts downward pressure on the client's distal forearm while the client attempts to maintain this position. Bicipital tendinopathy is likely if this procedure causes pain in the anterior shoulder region and there are other supporting indicators of tendinopathy. A variation on this test that may be a little more sensitive at picking up tendon pathology involves movement during the test. From the initial starting position of resisted shoulder fl exion, the therapist slowly overcomes the client's resistance to shoulder fl exion, causing the shoulder to slowly extend (eccentric contraction across the shoulder joint). With this variation, there is some movement of the tendon within the bicipital groove and the slight movement may give a more specifi c indication of tendon pathology. Several other conditions may present signs and symptoms similar to bicipital tendinopathy and should be considered when formulating a treatment plan. Rotator cuff pathology will often have pain in the same region. Tears or tendinosis of the supraspinatus or subscapularis muscles may refer pain into the same region as that of bicipital tendinopathy. Degenerative arthritis or sprains of the acromioclavicular (AC) joint may also cause chronic pain in the anterior shoulder region near the bicipital tendon. However, pain with the AC this ligament may be somewhat loose through individual genetic differences or from a previous injury. If this ligament is loose, the tendon may partially dislocate out of the bicipital groove during certain shoulder motions. Repeated subluxation of the tendon out of the groove may also lead to the fi ber degeneration of bicipital tendinopathy. ASSESSMENT The fi rst clue in identifying bicipital tendinopathy is a history of repetitive shoulder motion or other movements (forearm supination) that signifi cantly use the biceps muscle. Repetitive shoulder motion is common but not required to develop bicipital tendinopathy. Other factors, such as using antibiotics in the fl uoroquinolone family, can cause tendinopathy without any repetitive shoulder motion at all. The pain from bicipital tendinopathy is usually felt on the anterior aspect of the shoulder, although it can also radiate down the arm. The client may complain of pain being worse at night because certain sleeping positions compress the subacromial region and irritate the tendon. Night pain is also characteristic of rotator cuff pathology. Palpation is an important part of the evaluation strategy for bicipital tendinopathy. The tendon feels like a long pencil-sized structure on the anterior aspect of the shoulder, usually near the medial edge of the anterior deltoid. It is sometimes easier to feel its location with a moderate pressure, back and forth (medial to lateral) palpation of the anterior shoulder. Pain and tenderness with palpation are likely over the anterior shoulder region. If the tendon is palpated and the shoulder is then slowly internally or externally rotated underneath the palpating fi nger, pain is likely if bicipital tendinopathy is present. Excessive pressure isn't required when examining for tendon irritation. Active motion that uses the involved tendon may also be painful, especially if there is a load on the muscle (such as lifting a weight overhead). Pain is most likely in fl exion (shoulder or elbow) or forearm supination. In most cases of tendinopathy, passive movements that shorten the involved muscle-tendon unit (fl exion and supination in this case) are not painful because they take the load off the affected tissues. Pain is not common with passive motion that shortens the muscle-tendon unit because the tensile load is removed from the tendon. However, with bicipital tendinopathy, pain during passive shoulder fl exion or abduction may occur because the tendon gets pinched under the coracoacromial arch, even if there is no load on it. Passive motion in shoulder extension with the elbow extended may be painful as well. This position will stretch the biceps brachii and, therefore, put tensile stress on the tendon and potentially reproduce the pain. Shoulder extension with elbow extension also pulls the tendon more fi rmly against the upper humeral head during Based on what we now know about overuse tendon disorders, various massage approaches can be very helpful in addressing this problem and alleviating the client's complaint. Watch "Speed's Test" 98 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 9