Biceps Tendon Injection

Aka: Biceps Tendon Injection, Long Head of Biceps Injection, Injection of Long Head of Biceps

1. See also
   1. Shoulder Injection
   2. Glenohumeral Joint Injection
   3. Acromioclavicular Joint Injection
   4. Subacromial Space Injection
   5. Scapulothoracic Injection
   6. Joint Injection
   7. Injectable Corticosteroid
2. Indications
   1. Bicipital Tendonitis
3. Preparation
   1. Needle: 27 gauge, 1 to 1.5 inch
   2. Corticosteroid
      1. Methylprednisolone: 0.25 ml of 40 mg/ml (10 mg) or
      2. Betamethasone (Celestone Soluspan): 0.5 ml of 6 mg/ml (3 mg)
   3. Lidocaine 1%: 1-2 ml
4. Patient positioning
   1. Patient sits with arm resting at side
5. Approach
   1. Images
      1. 
   2. Landmarks
      1. Identify bicipital tendon in bicipital groove (proximal Humerus)
      2. Mark point of maximal tenderness over groove
   3. Injected with sterile technique (with betadine preparation of skin)
      1. Direct needle parallel to bicipital groove (vertically oriented)
      2. Needle enters skin at 30 degrees oriented superiorly
      3. Do not inject bicipital tendon
      4. Infiltrate area around groove, but not into tendon
         1. Flow resisted when needle is inside tendon
         2. Withdraw needle slightly and retry
         3. Continue to withdraw until not in tendon
6. Complications
   1. Bicipital tendon rupture
      1. Associated with intratendinous injection
      2. Do not inject bicipital tendon
7. References
   1. Pfenninger (1994) Procedures, p. 1036-54
   2. Larson (1996) Am Fam Physician 53(5):1637-43
   3. Tallia (2003) Am Fam Physician 67(6):1271-8