Diagnostic Approach and Clinical Considerations for Biceps Tendon Pathology

Diagnostic Approach

• MRI is the most accurate imaging modality for diagnosing biceps tendon tears, with an accuracy of 86.4% compared to ultrasound (45.5%) 1
• Plain radiographs should be the first imaging study to rule out associated fractures or bony abnormalities 1, 2
• The FABS (flexion-abduction-supination) view is recommended for optimal visualization of the biceps tendon on MRI 1, 2

Clinical Considerations

• The American Academy of Orthopaedic Surgeons is unable to recommend for or against biceps tenotomy or tenodesis when performing shoulder arthroplasty in patients with glenohumeral osteoarthritis due to insufficient evidence 3, 4
• Surgical practice regarding biceps tendon management during arthroplasty is largely based on anecdotal experience rather than evidence 3, 4

Pitfalls to Avoid

• Failing to distinguish between partial and complete tears, which requires accurate imaging (preferably MRI) 1, 2
• Relying solely on ultrasound for diagnosis, which has limitations in accuracy compared to MRI 1, 2