Background and indications: Bicipital tendinosis is a common clinical problem. The biceps tendon is susceptible to repeated compression loads with impingement mechanics.¹ Furthermore, anywhere a tendon curves around bone, there is increased compression forces that make a tendon susceptible to degenerative changes. Because of the susceptibility to tendinosis, and rupture of the biceps tendon, extra caution should be taken to avoid an intratendinous injection with steroids. Ultrasound-guided injections provide an accurate way to target the peritendinous sheath of the biceps tendon. In a study on 30 patients, Hashiuchi et al.² documented that 40% of blind injections that were directed to the biceps tendon sheath resulted in injections inside the tendon, or away from the target. Ultrasound-guided injections has been shown to provide a statistically significant better outcome when compared to blind injections.³ Of note, there is an ascending branch of the anterior circumflex artery that typically runs laterally to the biceps tendon. Prior to injection, it is helpful to apply the color Doppler and identify this regional blood vessels so that one can avoid injury to the vessel or intra-arterial injection. Some prefer to perform the injection routinely on the medial aspect of the tendon in order to avoid this vessel (Fig. 59.1).

Anatomy:

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