Rheumatology and Rehabilitation

Is the long biceps tendon torn – or not? This is often the question in the case of shoulder pain. However, the diagnosis is not always easy. When a physical examination does not provide a conclusive confirmation, magnetic resonance imaging (MRI) is often performed as advanced imaging, resulting in extra time for the patient and high costs. An ultrasound examination is an alternative. The advantage of ultrasound is that it can be performed directly during a consultation and delivers an accurate result immediately. However, its diagnostic value is highly dependent on the skill and experience of the person performing the examination. A tendon tear is not always easily recognizable, especially in older or stronger patients.

Our ultrasound team in the Rheumatology and Rehabilitation department has worked intensively on tackling this very challenge. In a recent specialist publication, the team describes a new, standardised procedure for the ultrasound examination of the long biceps tendon.

New guidance for easier examination

This brings with it a decisive change of perspective: instead of focusing directly on the tendon itself, the area where the muscle transitions into the tendon is examined, and its position is assessed. If it does not follow a certain pattern, this is a clear indication that the tendon has a tear. An alternative way of looking at it is using the example of a hanging plant pot: rather than checking the rope for defects, you look at how the pot is hanging.

This clear guidance increases diagnostic certainty and simplifies the examination. With the structured instructions, even colleagues with less experience, for example in GP practices, can assess more reliably whether the biceps tendon is torn. Further studies and instructions on this topic are in progress.

For patients, this translates into quicker clarity directly in the consultation, fewer unnecessary additional examinations and faster initiation of appropriate therapy. The project was developed in close cooperation with the Shoulder and Elbow Surgery department. This direct and straightforward interdisciplinary cooperation makes it possible to quickly apply new findings in practice – an approach that sets our clinic apart.

The Rheumatology department at Schulthess Klinik has a high level of expertise in ultrasound, both in providing precise diagnoses and in ultrasound-guided treatments. The team actively disseminates this knowledge through professional development, research and teaching, and training of specialists.