A 58-year-old male presents with anterior right shoulder pain after yard work; pain is reproduced by resisted supination of the elbow; most likely diagnosis?

• A. Supraspinatus tendonitis
• B. Subacromial bursitis
• C. Rotator cuff tear
• D. Bicipital tendonitis

Answer: (D)

Pain in the front of the shoulder that can be reproduced by resisting the forearm’s rotation points to irritation of the long head of the biceps tendon as it passes through the bicipital groove. This tendon is a common source of anterior shoulder pain when inflamed from overuse, such as repetitive gripping or lifting during yard work. The other conditions tend to produce different patterns: supraspinatus tendonitis usually causes lateral shoulder pain with weakness when lifting the arm; subacromial bursitis also tends to affect the outer shoulder and is linked to overhead activities; a rotator cuff tear typically presents with weakness and a limited range of motion rather than pain elicited specifically by resisted forearm supination. Thus, anterior shoulder pain reproduced with resisted forearm supination best fits bicipital tendonitis.