Although either fluoroscopy or US can be used as imaging guidance for biceps tendon injection, US guidance is more accurate [121]. US is more accurate in injection location placement compared with blind injections with a lower risk of intratendinous injection [122,123]. Many patients with sonographically normal biceps tendons may obtain pain relief with US-guided injection, suggesting that injection response may diagnostically identify patients with biceps pathology that is not seen by US [124]. MR Arthrography Shoulder MR arthrography may improve the accuracy of MRI in the detection of long head of the bicep tears, although results are mixed. Zanetti et al [125] found MR arthrography to be sensitive and moderately specific in the diagnosis of long head of the biceps tendon disorders with a sensitivity of 92% and a specificity of 56%. However, Loock et al [126] found a lower sensitivity and specificity for MR arthrography detection of biceps abnormalities, with only a 49% sensitivity for tendinopathy. Accuracy for middle-aged patients may be lower [127]. MR arthrography is moderately accurate at assessing for biceps tendon subluxation, with a sensitivity of 61% to 87% and a specificity of 83% to 92% [128]. MRI Shoulder Without and With IV Contrast There is insufficient evidence to support the use of MRI shoulder without and with IV contrast in the evaluation of chronic shoulder pain when biceps tendon abnormality is suspected. MRI Shoulder Without IV Contrast Standard noncontrast MRI is limited in detecting bicep abnormalities, including tendinopathy or tearing of the long head of the biceps. Studies have shown MRI to both under- and overdiagnose intra-articular biceps pathology [129- 131], with sensitivities and specificities of 28% and 84% (partial tear) and 56% and 98% (complete), respectively [130].
Chronic Shoulder Pain PCAs. Although either fluoroscopy or US can be used as imaging guidance for biceps tendon injection, US guidance is more accurate [121]. US is more accurate in injection location placement compared with blind injections with a lower risk of intratendinous injection [122,123]. Many patients with sonographically normal biceps tendons may obtain pain relief with US-guided injection, suggesting that injection response may diagnostically identify patients with biceps pathology that is not seen by US [124]. MR Arthrography Shoulder MR arthrography may improve the accuracy of MRI in the detection of long head of the bicep tears, although results are mixed. Zanetti et al [125] found MR arthrography to be sensitive and moderately specific in the diagnosis of long head of the biceps tendon disorders with a sensitivity of 92% and a specificity of 56%. However, Loock et al [126] found a lower sensitivity and specificity for MR arthrography detection of biceps abnormalities, with only a 49% sensitivity for tendinopathy. Accuracy for middle-aged patients may be lower [127]. MR arthrography is moderately accurate at assessing for biceps tendon subluxation, with a sensitivity of 61% to 87% and a specificity of 83% to 92% [128]. MRI Shoulder Without and With IV Contrast There is insufficient evidence to support the use of MRI shoulder without and with IV contrast in the evaluation of chronic shoulder pain when biceps tendon abnormality is suspected. MRI Shoulder Without IV Contrast Standard noncontrast MRI is limited in detecting bicep abnormalities, including tendinopathy or tearing of the long head of the biceps. Studies have shown MRI to both under- and overdiagnose intra-articular biceps pathology [129- 131], with sensitivities and specificities of 28% and 84% (partial tear) and 56% and 98% (complete), respectively [130].