Shoulder pain is a frequent orthopedic complaint, with biceps long head tendinitis being
a common cause leading to physical disability in the working and athletic population.
Currently, there's no guideline for managing biceps tendinitis. Studying clinical
outcomes post-biceps tendon sheath infiltration will aid in developing management
guidelines for quick patient return to activities with minimal sequelae.
No studies in Colombia have compared clinical outcomes of biceps tendinitis patients
undergoing ultrasound-guided vs anatomically guided infiltrations. This information will
allow comparison with global literature, assessing differences in treatment effectiveness
and socio-economic impact on the population.
Research Question:
In patients with long head biceps tendinitis, does ultrasound-guided infiltration
compared to anatomically guided infiltration yield better clinical outcomes?
Theoretical Framework and State of the Art:
The biceps tendon originates from the supraglenoid tubercle of the scapula, contributing
to shoulder stability and functions such as forearm supination and elbow flexion. Primary
biceps tendinitis, constituting about 5% of bicipital pathology cases, can limit daily
activities.
Tendinitis cascade initiation involves inflammation due to repetitive traction, leading
to increased tendon volume and pressure in specific locations, predisposing it to shear
forces and degenerative changes. Diagnosis involves ultrasound and MRI, with initial
treatment focusing on non-surgical methods and corticosteroid infiltrations when
conservative management fails.
Ultrasound-guided injections, compared to anatomical landmarks, show higher precision and
efficacy rates, reducing patient discomfort.
Procedure Technique:
Anatomical landmark-guided puncture involves patient positioning and palpation, whereas
ultrasound-guided involves identifying the biceps tendon's axis and inserting the needle
parallel to the transducer.
Objectives:
General Objective: To compare functional outcomes of biceps tendon sheath infiltration
guided by anatomical landmarks versus ultrasound in biceps tendinitis patients.
Specific Objectives: Characterize patient demographics, describe complication incidence,
compare complication incidence between groups, and compare clinical outcomes between
techniques.
Hypotheses:
Null Hypothesis: Ultrasound-guided infiltration yields similar functional results as
anatomical landmark-guided infiltration in biceps tendinitis patients.
Alternative Hypothesis: Ultrasound-guided infiltration yields better functional results
than anatomical landmark-guided infiltration in biceps tendinitis patients.
Methodology:
This entails a randomized clinical trial with double-blind methodology, involving RedCap
software for randomization. Patients are blinded to the procedure, while the applicator
knows the procedure but outcome evaluators are blinded.
Anatomical Landmark-guided Puncture:
The patient is placed in the supine position with the shoulder at a 10° internal rotation
angle. Identification involves palpation of the coracoid process, tuberosities, biceps
tendon, and bicipital groove. The tuberosities and biceps tendon groove are marked at the
presumed tendon location. Confirmation of tendon location is achieved through palpation
with rotations and manual palpation (highlighting 5 to 7 cm distal to the anterolateral
margin of the acromion). A 5cc syringe with a 0.8 x 40 mm 21G ½ needle is used for
puncture, inclined at a 20° to 30° cephalic angle until the biceps tendon sheath is
pierced. During the procedure, ultrasound machine and transducer positioning will be
performed, although the device will remain turned off.
Ultrasound-guided Puncture:
The patient is positioned supine with the shoulder in a neutral rotation. Identification
involves locating the axis of the long head biceps tendon. The transducer is positioned
perpendicular to the synovial sheath. The needle is inserted parallel to the transducer
along its long axis from the lateral side of the shoulder. The needle is visualized on
the monitor as a hyperechoic image and advanced continuously and in real-time into the
tendon sheath. A 5cc syringe with a 0.8 x 40 mm 21G ½ needle is used for puncture. This
procedure is performed by a specialist trained in ultrasound.
General Objective Compare the functional outcomes of bicipital groove infiltration guided
by anatomical landmarks and by ultrasound as a technique variation in patients with
biceps tendinitis.
Specific Objectives
Characterize demographic variables in the study patient groups. Describe the incidence of
complications related to the procedures. Compare the incidence of complications between
the groups. Compare clinical outcomes between the two techniques (EVA, qDASH, SANE,
satisfaction).
