Codman maneuver for biceps tendonitis: a prospective evaluation of a forgotten examination maneuver

Many physical exam maneuvers for shoulder pain exist, but the sensitivity and specificity are repeatedly found to be subpar, even in the most utilized maneuvers. Rotator cuff tendinopathy and biceps tendonitis are common pain generators that often go undifferentiated. The purpose of this study was to examine a century-old examination maneuver to help identify biceps tendinitis in patients presenting with anterior shoulder pain.

Twenty-seven consecutive patients who presented to clinic in a 10-month period with shoulder pain, no osseous concerns on radiographs, and subsequently received an ultrasound-guided corticosteroid injection (CSI) at the bicipital groove were prospectively enrolled. Our updated Codman maneuver was performed along with full and empty can tests in multiple planes. Visual analog scale (VAS) pain scores for each maneuver and isometric strength for the full and empty can tests were compared between patients who improved with ultrasound-guided CSI at the bicipital groove and those who did not.

24 of 27 patients responded favorably to CSI. Of these 24 patients, mean VAS scores across full and empty can maneuvers ranged from 4.4 (±3.2) to 5.5 (±3.0). Codman for biceps had a significantly higher mean VAS at 8.8 (±1.0). Conversely, Codman for supraspinatus had a significantly lower mean VAS score of 3.2 (±2.8).

The described Codman maneuver for biceps was correlated with patients who benefited from an ultrasound-guided CSI at the bicipital groove. Combining the Codman maneuver with patient-reported VAS pain scale is a promising maneuver for biceps tendinopathy.