Biceps Tendon Injection

Biceps Tendon Injection with steroid is used in case of chronic tendinitis of the long head of biceps tendon.

Equipment Needed

The Equipment Needed in Biceps Tendon Injection:

• Syringe: 1 ml
• Needle: Blue, 23 gauge, 1–1.25 inches, (25–30 mm)
• Kenalog 40: 10 mg
• Lidocaine: 0.75 ml, 2%
• Total volume: 1 ml

Related Anatomy

The long head of the biceps lies within a sheath in the bicipital groove between the greater and lesser tuberosities. It can be palpated by having the patient contract the muscle under the palpating finger in the groove.

See Also: Long Head of Biceps Tendon

Biceps Tendon Injection Technique

• Patient sits with supported elbow held at a right angle
• Identify tender area of tendon
• Insert needle perpendicular to skin at the highest part of tenderness and then angle downwards parallel to tendon
• Inject solution as a bolus between tendon and sheath.

See Also: Biceps Tendonitis

Aftercare

Advise relative rest for about a week and then address the causes of the lesion and strengthening of the rotator cuff.

Practice point

There should be little or no resistance felt to the passage of the fluid. This lesion is commonly diagnosed but is, in our experience, quite rare. Palpation of what is normally a tender area can lead to a misdiagnosis of this tendinitis when it might be pain referred from the cervical spine, shoulder joint or rotator cuff lesion. If there is a sudden onset of pain on flexing, a distinct bulge can appear midhumerus, indicating rupture of the long head of biceps. After the pain has subsided, the patient is usually able to function normally because the short head is sufficient to take over flexion activities.

Potential complications include:

1. pain,
2. infection,
3. bleeding,
4. damage to nearby structures,
5. allergic reaction, and non-therapeutic results.
6. Complications specific to steroid use include septic arthritis, post-injection flare, local tissue atrophy, skin discoloration, tendon rupture, cartilage damage, avascular necrosis, flushing, and increased blood glucose level.

References

1. Schwantes J, Byerly DW. Biceps Tendon Sheath Injection. [Updated 2022 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554412/