In the above case, the climber's discomfort was localized to the anterior shoulder and proximal arm. Repetitive overhead activities and lifting may exacerbate the pain, while rest usually brings relief. The pain may also intensify at night. Testing for biceps tendinitis is also important, since a positive finding may rule out a torn tendon. The area of tenderness is often found about 3 to 6 cm distal to the anterior acromion.
Weakness can be a sign of tendinitis or of tendon rupture.
Diagnosis can usually be made on the basis of the history and physical exam, but imaging may help rule out other conditions. Plain films of the shoulder can be helpful in the evaluation of biceps tendon ruptures thought to be associated with other shoulder pathology. The biceps groove view may demonstrate spurring of the groove, indicating chronic inflammation of the bicipital tendon. A supraspinatus outlet view may show evidence of supraspinatus outlet impingement syndrome. As in the present case, MRI may be useful in assessing biceps tendon anatomy and associated rotator cuff and intra-articular pathology.