Bicipital Tenosynovitis: Ortho Exam, LU 6 and Multiple Needles in a Line Needle Technique
The bicipital tenosynovitis injury and more will be presented and practiced in the upcoming Assessment and Treatment of Injury: Neck, Shoulder and Upper Extremity in New Jersey (December 4-8) and California (January 8-12, 2025).
Anterior shoulder pain is a common patient complaint and is often due to bicipital tenosynovitis, which is an irritation of the synovial sheath that covers the biceps tendon. Bicipital tenosynovitis usually creates pain before the actual tendon is affected and usually occurs from activities that require overhead arm motions. Because the bicipital tendon inserts above the head of the humerus into the glenoid labrum, the tendon is positioned to function as a strap for anterior stability of the humeral head. Therefore, in cases when a patient has a forward shoulder, the bicipital tendon and its synovial sheath are predisposed to increased wear and tear from the anterior misalignment of the humeral head. When combined with repetitive overhead activities, a forward shoulder leads to increased tension on the synovial sheath, which can result in pain, especially when the arm is lifted overhead.
The symptoms of bicipital tenosynovitis include dull, achy and sometimes sharp pain in the anterior shoulder in the region of extra points daijianzhen and jianneiling. The pain is typically worse with shoulder abduction and/or forward flexion. The common orthopedic examination is Speed’s Test; however, this test does not fully challenge the bicipital tendon when the humerus is forward. The author developed an examination that he prefers for this injury and believes it to be a more accurate and sensitive test for diagnosing bicipital tenosynovitis.
Check out this video of the Bicipital Long Head Eccentric Test and how LU 6, the xi-cleft point of the Lung channel can immediately change the pain response from this test!
Here is a needle technique developed by the author based on the traditional TCM needle technique “Multiple Needles in a Line.”
Bicipital Long Head Tendon: Multiple Needles in a Line Needle Technique
Palpate the biceps long head tendon at the extra point daijianzhen, which is located in the depression directly under the edge of the clavicle approximately halfway between LU 2 and LI 15. The location of this extra point is where the biceps long head tendon can be palpated before it passes under¬neath the clavicle to attach to the glenoid labrum. Palpate the tendon in a cross-fiber direction from daijianzhen moving downward along the tendon approximately 2 inches in the direction of the medial side of jianneiling. Using the classical needle technique Pai Ci, the practitioner inserts three to four 1.5 inch/40 mm needles obliquely on each side of the tendon starting from daijianzhen and continuing along the edge of the biceps long head tendon.
For more information, check out the following:
About the author(s):
Matt Callison is the president of the Sports Medicine Acupuncture Certification program. He has been combining sports medicine and traditional Chinese medicine (TCM) for over 26 years. He is the author of the Motor Point and Acupuncture Meridians Chart, the Motor Point Index, The Sports Medicine Acupuncture textbook and many articles on the combination of sports medicine and TCM.
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About the author(s):
Matt Callison is the president of the Sports Medicine Acupuncture Certification program. He has been combining sports medicine and traditional Chinese medicine (TCM) for over 26 years. He is the author of the Motor Point and Acupuncture Meridians Chart, the Motor Point Index, The Sports Medicine Acupuncture textbook and many articles on the combination of sports medicine and TCM.