Skip to main content
SpringerLink
Log in

Biceps Biceps Tendon

  • Chapter
Normal and Pathological Anatomy of the Shoulder

  • 4059 Accesses

Abstract

The long head of biceps (LHB) is a common source of shoulder pain. The LHB with an intraarticular extrasynovial and an extraarticular portion is exposed to both extraarticular and intraarticular restrictions. A pulley mechanism contributes to the stability of the tendon, and its failure can lead to instability.

The LHB has a characteristic pattern of irrigation and innervation. The presence of a network of sympathetic fibers may explain the origin of bicipital pain. The LHB functions vary from that of no role to a possible role in glenohumeral kinematics.

Ultrasound and magnetic resonance imaging (MRI) has been used to evaluate biceps pathology. Gadolinium-enhanced MRI increases diagnostic accuracy.

LHB pathology may consist of tenosynovitis, tendinosis, hourglass constriction, partial/complete tears, or labrobicipital injuries (SLAP).

Conservative treatment is the frontline in most of LHB pathology. Activity modifications, NSAIDs, physical therapy, and subacromial, intraarticular or tendon sheath infiltrations are generally useful for symptom management.

Surgical treatment is reserved for chronic or hypertrophic tenosynovitis, some SLAP tears, biceps instability, tenosynovitis, and partial rotator cuff tears. Arthroscopic tenotomy or tenodesis are the surgical treatments of choice.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ahrens PM, Boileau P. The long head of biceps and associated tendinopathy. J Bone Joint Surg Br. 2007;89(8):1001–9.

    Article  CAS  PubMed  Google Scholar 

  2. Alpantaki K, et al. Sympathetic and sensory neural elements in the tendon of the long head of the biceps. J Bone Joint Surg Am. 2005;87(7):1580–3.

    Article  PubMed  Google Scholar 

  3. Andrews JR, Carson WG, McLeod WD. Glenoid labrum tears related to the long head of the biceps. Am J Sports Med. 1985;13(5):337–41.

    Article  CAS  PubMed  Google Scholar 

  4. Arai R, Mochizuki T, Yamaguchi K, Sugaya H, Kobayashi M, Nakamura T, Akita K. Functional anatomy of the superior glenohumeral and coracohumeral ligaments and the subescapularis tendon in view of stabilization of the long head of the biceps tendon. J Shoulder Elbow Surg. 2010;19:58–64.

    Article  PubMed  Google Scholar 

  5. Barber FA, Field LD, Ryu RK. Biceps tendon and superior labrum injuries: decision making. J Bone Joint Surg Am. 2007;89-A:1–14.

    Google Scholar 

  6. Beall DP, et al. Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff. AJR Am J Roentgenol. 2003;180(3):633–9.

    Article  PubMed  Google Scholar 

  7. Ben Kibler W, et al. Clinical utility of traditional and New tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Am J Sports Med. 2009;37(9):1840–7.

    Article  CAS  PubMed  Google Scholar 

  8. Bennett WF. Specificity of the Speed’s test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy. 1998;14(8):789–96.

    Article  CAS  PubMed  Google Scholar 

  9. Boileau P. Long head of the biceps pathology, to tenodese or to repair. In: Instructional Course Lecture. American Academy of Orthopaedic Surgeons (AAOS) Congress; 2014.

    Google Scholar 

  10. Boileau P, Ahrens PM, Hatzidakis AM. Entrapment of the long head of the biceps tendon: the hourglass biceps, a cause of pain and locking of the shoulder. J Shoulder Elbow Surg. 2004;13(3):249–57.

    Article  PubMed  Google Scholar 

  11. Boileau P, et al. Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation. Arthroscopy. 2002;18(9):1002–12.

    Article  PubMed  Google Scholar 

  12. Boileau P, et al. Arthroscopic treatment of isolated type II SLAP lesions: biceps tenodesis as an alternative to reinsertion. Am J Sports Med. 2009;37(5):929–36.

    Article  PubMed  Google Scholar 

  13. Borrero CG, et al. Magnetic resonance appearance of posterosuperior labral peel back during humeral abduction and external rotation. Skeletal Radiol. 2010;39(1):19–26.

    Article  PubMed  Google Scholar 

  14. Braun S, et al. Lesions of the biceps pulley. Am J Sports Med. 2011;39(4):790–5.

    Article  PubMed  Google Scholar 

  15. Broca P. La torsion de I’humérus et le tropomêtre, instrument destiné à mesurer la torsion des os (rédigrée par L. Mamouvier). Revue d’Anthrop 2ême serie. 1881;4:193–1592.

    Google Scholar 

  16. Burkhart SS, Morgan CD. The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy. 1998;14(6):637–40.

    Article  CAS  PubMed  Google Scholar 

  17. Burkhead W, et al. The biceps tendon. In: Rockwood CA, Matsen FA, editors. The shoulder. Philadelphia: Saunders; 1998. p. 1009–63.

    Google Scholar 

  18. Burks R. Biceps tendon. In: Instructional Course Lecture 409, How about that proximal biceps tendon? New Orleans: American Academy of Orthopaedic Surgeons; 2013.

    Google Scholar 

  19. Claessens H, Snoeck H. Tendinitis of the long head of the biceps brachii. Acta Orthop Belg. 1972;58(1):124–8.

    CAS  PubMed  Google Scholar 

  20. Cook C, et al. Diagnostic accuracy of five orthopedic clinical tests for diagnosis of superior labrum anterior posterior (SLAP) lesions. J Shoulder Elbow Surg. 2012;21(1):13–22.

    Article  PubMed  Google Scholar 

  21. Cooper DE, et al. Anatomy, histology, and vascularity of the glenoid labrum. An anatomical study. J Bone Joint Surg Am. 1992;74(1):46–52.

    CAS  PubMed  Google Scholar 

  22. Di Giacomo G. Atlas of functional shoulder anatomy. Italia: Springer; 2008.

    Book  Google Scholar 

  23. Dierickx C, et al. Variations of the intra-articular portion of the long head of the biceps tendon: a classification of embryologically explained variations. J Shoulder Elbow Surg. 2009;18(4):556–65.

    Article  PubMed  Google Scholar 

  24. Duplay S. La Périarthrite ScapuloHuméral. Gaz Hôp Paris, Arch Gen Med. 1872;69:571–3.

    Google Scholar 

  25. Elser F, et al. Anatomy, function, injuries, and treatment of the long head of the biceps brachii tendon. Arthroscopy. 2011;27(4):581–92.

    Article  PubMed  Google Scholar 

  26. Favorito PJ, Harding III WG, Heidt Jr RS. Complete arthroscopic examination of the long head of the biceps tendon. Arthroscopy. 2001;17(4):430–2.

    Article  CAS  PubMed  Google Scholar 

  27. Gobezie R, et al. Analysis of interobserver and intraobserver variability in the diagnosis and treatment of SLAP tears using the Snyder classification. Am J Sports Med. 2008;36(7):1373–9.

    Article  PubMed  Google Scholar 

  28. Gorantla K, Gill C, Wright RW. The outcome of type II SLAP repair: a systematic review. Arthroscopy. 2010;26(4):537–45.

    Article  PubMed  Google Scholar 

  29. Habermeyer P, et al. Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elbow Surg. 2004;13(1):5–12.

    Article  PubMed  Google Scholar 

  30. Habermeyer P, et al. Classifications and scores of the Shoulder. Berlin/Heidelberg: Springer; 2006. p. 35–40.

    Google Scholar 

  31. Hitchcock H, Bechtol C. Painful shoulder; observations on the role of the tendon of the long head of the biceps brachii in its causation. J Bone Joint Surg Am. 1948;30A(2):263–73.

    CAS  PubMed  Google Scholar 

  32. Hsu A, et al. Biceps tenotomy versus tenodesis: a review of clinical outcomes and biomechanical results. J Shoulder Elbow Surg. 2011;20(2):326–32.

    Article  PubMed  Google Scholar 

  33. Jarret CD, et al. Minimally invasive proximal biceps tenodesis: an anatomical study for optimal placement and safe surgical technique. J Shoulder Elbow Surg. 2011;20(3):477–80.

    Article  Google Scholar 

  34. Khazzam M, George M, Churchill S, Kuhn J. Disorders of the long head of biceps tendon. J Shoulder Elbow Surg. 2012;21(1):136–45.

    Article  PubMed  Google Scholar 

  35. Krahl VE. Visible evidence of humeral torsion; the bicipital groove. Am J Phys Anthropol. 1948;6(2):241.

    CAS  PubMed  Google Scholar 

  36. LaFrance R, et al. Relevant anatomic landmarks and measurements for biceps tenodesis. Am J Sports Med. 2013;41(6):1395–9.

    Article  PubMed  Google Scholar 

  37. Longo UG, et al. Characteristics at haematoxylin and eosin staining of ruptures of the long head of the biceps tendon. Br J Sports Med. 2009;43(8):603–7.

    Article  CAS  PubMed  Google Scholar 

  38. Maffet MW, Gartsman GM, Moseley B. Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med. 1995;23(1):93–8.

    Article  CAS  PubMed  Google Scholar 

  39. Martin C. De la direction des axes du col et des condyles du femur et de l’humerus dans les mammiferes, les oiseaux et les reptiles. Compt Rend Acad Sci. 1857;44:1027–9.

    Google Scholar 

  40. McCormick F, et al. The efficacy of biceps tenodesis in the treatment of failed superior labral anterior posterior repairs. Am J Sports Med. 2014;42(4):820–5.

    Article  PubMed  Google Scholar 

  41. McCulloch P, et al. The effect on external rotation of an anchor placed anterior to the biceps in type 2 SLAP repairs in a cadaveric throwing model. Arthroscopy. 2013;29(1):18–24.

    Article  PubMed  Google Scholar 

  42. Monteggia G. Instituzione Chirurgiche. Milan: G Truffi; 1829. p. 170.

    Google Scholar 

  43. Morag Y, et al. MR arthrography of rotator interval, long head of the biceps brachii, and biceps pulley of the shoulder1. Radiology. 2005;235(1):21–30.

    Article  PubMed  Google Scholar 

  44. Morgan CD, et al. Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy. 1998;14(6):553–65.

    Article  CAS  PubMed  Google Scholar 

  45. Murthi AM, Vosburgh CL, Neviaser TJ. The incidence of pathologic changes of the long head of the biceps tendon. J Shoulder Elbow Surg. 2000;9(5):382–5.

    Article  CAS  PubMed  Google Scholar 

  46. Nakata W, et al. Biceps pulley: normal anatomy and associated lesions at MR arthrography. Radiographics. 2011;31(3):791–810.

    Article  PubMed  Google Scholar 

  47. Nho SJ, et al. Long head of the biceps tendinopathy: diagnosis and management. J Am Acad Orthop Surg. 2010;18(11):645–56.

    PubMed  Google Scholar 

  48. Pasteur F. Les algies de L’epaule et al physiothérapie, La téno-bursite bicipitale. J Radiol Electrol. 1932;16:419–29.

    Google Scholar 

  49. Powell SE, Nord KD, Ryu RKN. The diagnosis, classification and treatment of SLAP lesions. Oper Tech Sports Med. 2004;12:99–110.

    Article  Google Scholar 

  50. Sanders B, et al. Clinical success of biceps tenodesis with and without release of the transverse humeral ligament. J Shoulder Elbow Surg. 2012;21(1):66–71.

    Article  PubMed  Google Scholar 

  51. Sayde WM, et al. Return to play after Type II superior labral anterior-posterior lesion repairs in athletes: a systematic review. Clin Orthop Relat Res. 2012;470(6):1595–600.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Skendzel JG, et al. Long head of biceps brachii tendon evaluation: accuracy of preoperative ultrasound. Am J Roentgenol. 2011;197(4):942–8.

    Article  Google Scholar 

  53. Slenker NR, et al. Biceps tenotomy versus tenodesis: clinical outcomes. Arthroscopy. 2012;28(4):576–82.

    Article  PubMed  Google Scholar 

  54. Snyder SJ, et al. SLAP lesions of the shoulder. Arthroscopy. 1990;6(4):274–9.

    Article  CAS  PubMed  Google Scholar 

  55. Soden J. Two cases of dislocation of the tendon of the long head of the biceps humeri from its groove. Med Chir Trans. 1841;24:212–20.

    PubMed Central  CAS  PubMed  Google Scholar 

  56. Tennent TD, Beach WR, Meyers JF. A review of the special tests associated with shoulder examination. Part II: laxity, instability, and superior labral anterior and posterior (SLAP) lesions. Am J Sports Med. 2003;31(2):301–7.

    PubMed  Google Scholar 

  57. Tuoheti Y, et al. Attachment types of the long head of the biceps tendon to the glenoid labrum and their relationships with the glenohumeral ligaments. Arthroscopy. 2005;21(10):1242–9.

    Article  PubMed  Google Scholar 

  58. Vangsness CT, et al. The origin of the long head of the biceps from the scapula and glenoid labrum. An anatomical study of 100 shoulders. J Bone Joint Surg. 1994;76(6):951–4.

    Google Scholar 

  59. Verma N. Long head biceps tendon: surgical techniques and complications. Instructional Course Lecture 271. Biceps Tendon: problems and surgical techniques. San Francisco: American Academy of Orthopaedic Surgeons; 2012.

    Google Scholar 

  60. Verma NN, Drakos M, O’Brien SJ. The arthroscopic active compression test. Arthroscopy. 2005;21(5):634.e1–4.

    Article  Google Scholar 

  61. Wittstein JR, et al. Isokinetic strength, endurance, and subjective outcomes after biceps tenotomy versus tenodesis: a postoperative study. Am J Sports Med. 2011;39(4):857–65.

    Article  PubMed  Google Scholar 

  62. Wolf BR, et al. Agreement in the classification and treatment of the superior labrum. Am J Sports Med. 2011;39(12):2588–94.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Clinica Las Condes, Santiago, Chile

    Vicente Gutierrez MD & Max Ekdahl MD

  2. Department of Orthopaedic Surgery, Flinders University, Bedford Park, SA, Australia

    Levi Morse

Authors
  1. Vicente Gutierrez MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Max Ekdahl MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Levi Morse
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vicente Gutierrez MD .

Editor information

Editors and Affiliations

  1. Department of Orthopedics and Trauma, Flinders University, Adelaide, South Australia, Australia

    Gregory I. Bain

  2. Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan

    Eiji Itoi

  3. Orthopaedic, Concordia Hospital for Special Surgery, Rome, Italy

    Giovanni Di Giacomo

  4. Funabashi Orthopaedic Sports Med Cn Shoulder & Elbow Service, Chiba, Japan

    Hiroyuki Sugaya

Rights and permissions

Reprints and permissions

Copyright information

© 2015 ISAKOS

About this chapter

Cite this chapter

Gutierrez, V., Ekdahl, M., Morse, L. (2015). Biceps Biceps Tendon. In: Bain, G., Itoi, E., Di Giacomo, G., Sugaya, H. (eds) Normal and Pathological Anatomy of the Shoulder. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45719-1_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-45719-1_14

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-45718-4

  • Online ISBN: 978-3-662-45719-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation