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In this video we will be talking about proximal proximal biceps tendinopathy. This is a shoulder dysfunction, compared to distal biceps tendinopathy which involves pain in closer proximity to the elbow.

OVERVIEW (00:20)
This is an irritation of the long head of the biceps near the origin of the muscle (at the shoulder). This can be a mild issue, or quite serious.
It may be a simple tendinopathy
This may be a biomechanical issue, BUT
It can be the precursor to a biceps rupture.
Or, it can also be a sign of a labral tear as the tendon for this inserts into the labrum of the shoulder.
Basically, this is a complex issue and if you don't get the answers you need from this video, seek professional help.

BIOMECHANICS (00:32)
This is most often a biomechanical issue but when it comes to climbing we need to look at our training and climbing styles. If you are doing a lot of hangs in full shoulder extension you could be causing impingement. If you’re climbing with your elbows always bent this could be an issue or. If Monday, Wednesday, and Friday are all Biceps days, you may be doing too much.

But, this IS MOST LIKELY a biomechanical issue. The long head of the bicep is prone to irritation from the humerus being too anteriorly translated or if the scapula does not have proper upward rotation during overhead activities. If the humerus is too anterior, the LHB in a sense acts as a restraining device to keep the shoulder in place, definitely not what it is designed to do. Whereas if you have poor muscle fire, coordination, or weakness in some of the upward rotators of the shoulder, the LHB may be getting compressed during overhead activities, such as climbing.

So how do you know what you have? Well, if you have noticed you have terrible posture and your shoulders are always forward and you are slouched often, your shoulders / the humerus is likely sitting too far anterior. A professional can easily assess this and help with your treatment. What about the mechanics?

If you notice your pain is worse when you are reaching overhead, it may be a mechanical issue of poor upward rotation. In order to treat that, you likely will need to strengthen the rotator cuff and certain scapular muscles. A professional would be best for this, but you can always check out our shoulder strengthening series. Look at your weakness and go from there.

SIGNS AND SYMPTOMS (03:17)
The pain from LHBT tendinopathy is often focused in the anterior shoulder; the pain may radiate distally over the biceps muscle. If you have this issue, you may have a painful arc of motion associated with a click, and pain that worsens at night. Symptoms are gradual in onset, if your symptoms are sudden and acute, you may have a separate issue.

TESTING (04:06)
The best way to test for this is with a multimodal approach. It will involve range of motion, strength, special tests, and palpation.
Range of motion: First, just be safe and test your range. If you can't fully flex your elbow without pain, or you cannot lift your shoulder overhead without pain, you may want to hold off on testing your strength as this may further irritate the issue. Once you've assured you have full elbow and shoulder range of motion, we can move on to strength.
Strength: First, test your elbow flexion strength with your forearm in the thumb up position, this places less stress on the LHB so it is safer. If this causes pain, stop there, otherwise continue to the palm up position. If you have no pain in the palm up position as well, move onto our special tests.

BONUS Differential Diagnosis (09:56)
FINAL NOTE (11:20)
BLOOPERS (11:50)
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** FOR THE FULL, INDEPTH SHOW NOTES including TREATMENT and DIFFERENTIAL DIAGNOSIS click the link below to our blog! Unfortunately, all this great material cannot be covered in just 5000 characters. **
https://www.rocktherapypt.com/blog

For information about good exercises for scapular retraction strength check out the link below!
   • Top 4 Shoulder Retractor Exercises | ...  


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Written and Presented by Jason Hooper, PT, DPT, OCS, CAFS
IG: @hoopersbetaofficial

Filming and Editing by Emile Modesitt
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