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Injury can result from overuse, but it also can occur with tendon overload after a cuff tear.
Clinically, the patient complains of point pain over the long head of biceps tendon. Resisted shoulder flexion with supination and passive shoulder extension are painful.
Ultrasound shows fluid in the biceps tendon sheath, and the long head of biceps tendon can appear thickened and hypoechoic. Neovascular changes can occur in the tendon and in the surrounding tendon sheath. Often this coexists with an old undiagnosed rotator cuff tear.
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