b'CODING Update ComplianceLEGAL NUTRITIONUpdateANJC NewsANJC Leadership ANJC News! NUTRITION LEGAL EASEANJC Scholarships REHAB Update CHIRO AssistExecutive Directors Update LEGAL Q&A2020 ANJC AWARDSINSURANCE Update INSURANCE Update Legislative UpdateTECHNIQUE UpdateBiceps Tendinopathy:MedicareQ&AMedicare Update Etiological origins, OUR HEALTHAssessment Protocols andBy Dr. Christine Foss Treatment RegimesBiceps tendinopathy is a term given to a persistent painto grasp is that the bicep tendon sits in the intertubercular in the bicep tendon secondary to chronic and noxiousgroove.This intertubercular groove acts as a gutter system mechanical load.This more than common complaint in allfor the waterfall of inflammation from the shoulder.Under-age and cross sections of our patient population, has anstanding this relationship of the structures as they sit in the untold story as to its origin that needs to be considered insubacromial region (supraspinatus tendon, bursae, labrum the assessment and treatment of anterior shoulder pain. etc.) and the potential of them as causative agents in most Diving into evaluation regimes to uncover the causativecases of shoulder inflammation.factor that is revealed as proximal biceps tendinopathyThe research study by O. Kenechi et al, Volume and is critical to full recovery of the patient.In doing this, anMovement Affecting Flow of Injectate between biceps accurate diagnosis is made, and the proper treatment istendon sheath and glenohumeral joint: A Cadaveric Study, incorporated into the patients care path.In uncovering theKenechi demonstrates how this flow of material from the etiological origins of biceps tendinopathy, we need to firstglenohumeral space traverses into the region of the Biceps understand the tendon histology.The tendinous structuretendon.This is confirmation of the fact that inflammation that exists as the bicep tendon is composed of a tendonousfrom the structures in and around the glenohumeral joint sheath, dense collagen type one and three, as well as elastincould be causative agents in biceps tendon and tendon fibers.These structures are all arranged in a longitudinalsheath inflammation.Of equal importance is to note the and uniform pattern in the healthy tendon.With movement,research that demonstrates disorders of the long head of the tendon glides in the sheath. The longitudinal coordi- the biceps tendon and its correlated to rotator cuff tears in nation of the fibers allows for a structure that is responsiveup to 90% of cases.This has been shown to be due to the to movement and load in a functional and synchronouspressure and friction in the region of the glenohumeral joint manner. and hence the biceps tendon.The first question in evaluation of a suspected biceps tendinopathy should be why?In other words, why is thereChristine Foss, MD, DC, MSEd, ATC, DACBSP, ICCSP, is inflammation, adhesions or pain in the anterior shoulderco-owner of Advanced Sports Medicine & Physical Therapy with activity?Understanding this is the true key in not onlyCenter NJ in Riverdale.She is an ANJC member and past treating, but rehabilitating this region fully. The key conceptpresident of the NJCCSIR.BICEPSTENDINOPATHY18 I Summer 2021 www.anjc.info'