Chronic Tenovaginitis of the Long Head of the Biceps

A patient comes to the rheumatoid consulting centre because of pains in the shoulder which suddenly began during one day 3 years ago. Since the time she has had permanent pains. Numerous steroid peritendinous injection into the shoulder joint which has only a minimal effect. The patient cannot lie on the shoulder, she has a feeling of a swollen shoulder on the inner side. Once she had “water” in the knee a few years ago which disappeared after a peritendinous injection by orthopaedist. But she thinks that it was due to an injury from that time. She has no pain in other joints.

Objective Finding

A painful palpation of the long head of the biceps, a swelling in the medial area of the shoulder.

Extension of the Movement

An elevation in flexion and also in abduction is restricted, a painful arc is there.

An active and passive flexion, an outer rotation and an abduction in the glenohumeral articulation is restricted and painful in the outer position.

A painful abduction 12 and a flexion, outer rotation against the resistance.

 

 

Ultrasound Examination

Clear tenosynovitis of the long head of the biceps, other structures during the ultrasound are in norm.

picture and scheme of tenosynovitis of the long head of the biceps in the transversal section at the ultrasound

videosequence of tenosynovitis of the long head of the biceps in the transversal section at the ultrasound

Aspiration of the Liquid from the Tendinous Sheath

A highly viscid liquid, pellucid, colourless.

Without any presence of cells and crystals.

Negative.

 

Therapy

At the patient an aspiration and an injection of 12 mg Depomedrol was made for several times, but without any success, therefore she was sent to the orthopaedics to solve the problem with an operation. A revision was made there, and tenosynovitis with a presence of highly viscid exudate was confirmed. A good resulting effect of  carried out tenosynovectomy. 

Conclusion

3 years lasting tenosynovitis of the long head of the biceps.

Commentary

At the described patient arthritis of a right wrist has occurred during a last half of a year, and we close its diagnosis as undifferentiated monoarthritis with tenosynovitis of the long head of the biceps in the anamnesis. Progress of hydrops of the knee in the anamnesis does not eliminate a bit active undifferentiated rheumatoid affection for the time being.