Palpation Of The Bicipital Groove And Tendon

Check the "drop-arm" sign. Ask the patient to fully abduct the arm to shoulder level (or up to 90°) and lower it slowly. (Note that abduction above shoulder level, from 90° to 120°, reflects action of the deltoid muscle.)

Rotate the arm and forearm externally and locate the biceps muscle distally near the elbow. Track the muscle and its tendon proximally into the bicipital groove along the anterior aspect of the humerus. As you check for tendon tenderness, rolling the tendon under the fingertips may be helpful.

Finally, hold the patient's elbow against the body with the forearm flexed at a right angle. Ask the patient to supinate the forearm against resistance.

The fibrous articular capsule and the broad flat tendons of the rotator cuff are so closely associated that they must be examined simultaneously. Swelling in the capsule and synovial membrane is often best detected by looking down on the shoulder from above. Palpate the capsule and synovial membrane beneath the anterior and posterior acromion.

The following maneuvers test individual muscles of the shoulder girdle and help localize pain. Note that medial rotation against resistance also tests the pec-toralis major, teres major, and latissimus dorsi. Additional evaluation of muscle strength, sensation over the neck, shoulder, and arm, and upper extremity reflexes is often warranted to complete your assessment (see pp. 573-575).

Articular Capsule, Synovial Membrane, and Glenohumeral Joint

Bicipital Groove Latismus Dorsi

Supraspinatus: Patient abducts against resistance.

Subscapularis: Patient rotates forearm medially against resistance.

If the patient is unable to hold the arm fully abducted at shoulder level, the "drop arm" test is positive, indicating a tear in the rotator cuff.

See also Bicipital Tendinitis in Table 15-4 Painful Shoulders (pp. 526-527).

Tenderness or pain against resistance occurs with tenosynovitis of the bicipital tendon sheath, tendinitis, or biceps tendon rupture.

Tenderness and effusion suggest synovitis of the glenohumeral joint. If the margins of the capsule and synovial membrane are palpable, a moderate to large effusion is present. Minimal degrees of synovitis at the glenohumeral joint cannot be detected on palpation.

Supraspinatus: Patient abducts against resistance.

Subscapularis: Patient rotates forearm medially against resistance.

Infraspinatus, teres minor: Patient rotates Thoracohumeral group: Patient adducts forearm laterally against resistance. forearm against resistance.

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Responses

  • amy
    How to palpate bicipital groove?
    2 years ago
  • Mikko
    How to locate bicipital groove?
    2 months ago
  • bryn
    How to put tendon back in bicipital groove?
    2 months ago

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