Image Interpretation: The biceps tendon is intact without any changes to its normal fibrillar echotexture or thickness. An anechoic fluid collection is noted within the tendon sheath along with isoechoic synovial thickening with marked hyperemia. These findings are suggestive of bicipital tenosynovitis. No biceps tendon subluxation is noted on dynamic evaluation. ​

Teaching Pearl: Ultrasound is an accurate diagnostic tool for the evaluation for the extra-articular portion of the long head of the biceps. Studies show a high diagnostic specificity (Short axis 90 percent specificity and 68 percent sensitivity, Long Axis 73 percent specificity and 81 percent sensitivity) with ultrasound close to MRA (98.3 percent specificity and 85.7 percent sensitivity), and with an experienced sonographer, this specificity can even be greater. For biceps tenosynovitis, point-of-care ultrasound allows efficient, accessible, affordable, and dynamic testing that can be used to allow more immediate treatment. The pathology results from inflammation causing hyperemia and subsequent swelling within the tendon sheath. While some people can have acute injuries from overuse, others have chronic injuries that occur with other shoulder pathologies leading to biomechanical disturbances. Conservative treatment may include NSAIDs, activity modification, and physical therapy. Additionally, ultrasound guided diagnostic and therapeutic injections can be done into the bicep tendon sheath using corticosteroids or anti-inflammatory medications like Ketorolac. Should conservative measures fail, surgery can be considered to help with areas that can be causing primary or secondary areas of impingement. Huang S, Wang W. Quantitative diagnostic method for biceps long head tendinitis by using ultrasound. Sci World J. 2013. 1 7.