Skip to main content
SpringerLink
Log in

Anatomy, Assesment, and Surgery of the Biceps Tendon

  • Chapter
  • First Online:
The Shoulder

Part of the book series: Orthopaedic Study Guide Series ((ORTHSTUDY))

  • 1484 Accesses

Abstract

Pathology of the Long Head of the Biceps Tendon (LBHT) is common and often associated with marked disability. The pathologies causing functional disabilities exist in many forms and are frequently associated with additional shoulder pathologies. Although the anatomy and anatomic variation of the LHBT and superior labrum have been well documented, data regarding the function and biomechanical properties of the LHBT are not consistent. Clinical and diagnostic examinations can accurately diagnoses LHBT pathology however, arthroscopy is a valuable tool with which to identify and treat biceps pathology. Surgical interventions for biceps pathology include debridement, decompression, tenotomy, and tenodesis. Multiple factors must be weighed when considering these surgical interventions. Surgical approach and restoring native or functional anatomy must be considered in addition to evaluating patient age, activity level, functional demand, compliance, and patient expectations in order to achieve optimal outcomes. This chapter will outline the functional anatomy, clinical presentation, physical examination and imaging, in addition to common pathologies and surgical treatments for biceps injuries.

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. Sarmento M. Long head of biceps: from anatomy to treatment. Acta Reumatol Port. 2015;40:26–33.

    CAS  PubMed  Google Scholar 

  2. Tuoheti Y, Itoi E, Minagawa H, 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;21:1242–9.

    Article  PubMed  Google Scholar 

  3. Cooper DE, Arnoczky SP, O’Brien SJ, et al. Anatomy, histology, and vascularity of the glenoid labrum. An anatomical study. J Bone Joint Surg Am. 1992;74:46–52.

    Article  CAS  PubMed  Google Scholar 

  4. Denard PJ, Dai X, Hanypsiak BT, et al. Anatomy of the biceps tendon: implications for restoring physiological length-tension relation during biceps tenodesis with interference screw fixation. Arthroscopy. 2012;28:1352–8.

    Article  PubMed  Google Scholar 

  5. Rao AG, Kim TK, Chronopoulos E, et al. Anatomical variants in the anterosuperior aspect of the glenoid labrum: a statistical analysis of seventy-three cases. J Bone Joint Surg Am. 2003;85-A:653–9.

    Article  PubMed  Google Scholar 

  6. Tena-Arregui J, Barrio-Asensio C, Puerta-Fonollá J, et al. Arthroscopic study of the shoulder joint in fetuses. Arthroscopy. 2005;21:1114–9.

    Article  PubMed  Google Scholar 

  7. Dierickx C, Ceccarelli E, Conti M, 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;18:556–65.

    Article  PubMed  Google Scholar 

  8. Becker DA, Cofield RH. Tenodesis of the long head of the biceps brachii for chronic bicipital tendinitis. Long-term results. J Bone Joint Surg Am. 1989;71:376–81.

    Article  CAS  PubMed  Google Scholar 

  9. Boesmueller S, Fialka C, Pretterklieber ML. The arterial supply of the tendon of the long head of the biceps brachii in the human: a combined anatomical and radiological study. Ann Anat. 2014;196:449–55.

    Article  PubMed  Google Scholar 

  10. Cheng NM, Pan WR, Vally F, et al. The arterial supply of the long head of biceps tendon: anatomical study with implications for tendon rupture. Clin Anat. 2010;23:683–92.

    Article  PubMed  Google Scholar 

  11. Braun S, Millett PJ, Yongpravat C, et al. Biomechanical evaluation of shear force vectors leading to injury of the biceps reflection pulley: a biplane fluoroscopy study on cadaveric shoulders. Am J Sports Med. 2010;38:1015–24.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. Cone RO, Danzig L, Resnick D, et al. The bicipital groove: radiographic, anatomic, and pathologic study. AJR Am J Roentgenol. 1983;141:781–8.

    Article  CAS  PubMed  Google Scholar 

  14. Athwal GS, Steinmann SP, Rispoli DM. The distal biceps tendon: footprint and relevant clinical anatomy. J Hand Surg. 2007;32:1225–9.

    Article  Google Scholar 

  15. Hutchinson HL, Gloystein D, Gillespie M. Distal biceps tendon insertion: an anatomic study. J Shoulder Elbow Surg. 2008;17:342–6.

    Article  PubMed  Google Scholar 

  16. 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;13:249–57.

    Article  PubMed  Google Scholar 

  17. Hegedus EJ, Goode A, Campbell S, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med. 2008;42:80–92; discussion.

    Google Scholar 

  18. Hegedus EJ, Goode AP, Cook CE, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46:964–78.

    Article  PubMed  Google Scholar 

  19. Yergason RM. Supination sign. J Bone Joint Surg. 1931;13:160.

    Google Scholar 

  20. Holtby R, Razmjou H. Accuracy of the Speed’s and Yergason’s tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Arthroscopy. 2004;20:231–6.

    Article  PubMed  Google Scholar 

  21. Gilcreest EL. Dislocation and elongation of the long head of the biceps brachii: an analysis of six cases. Ann Surg. 1936;104:118–38.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Ben Kibler W, Sciascia AD, Hester P, 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;37:1840–7.

    Article  CAS  PubMed  Google Scholar 

  23. Jobe FW, Moynes DR. Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries. Am J Sports Med. 1982;10:336–9.

    Article  CAS  PubMed  Google Scholar 

  24. Pandya NK, Colton A, Webner D, et al. Physical examination and magnetic resonance imaging in the diagnosis of superior labrum anterior-posterior lesions of the shoulder: a sensitivity analysis. Arthroscopy. 2008;24:311–7.

    Article  PubMed  Google Scholar 

  25. Christopher Patton W, McCluskey III GM. Biceps tendinitis and subluxation. Clin Sports Med. 2001;20:505–29.

    Article  Google Scholar 

  26. Rokito AS, Bilgen OF, Zuckerman JD, et al. Medial dislocation of the long head of the biceps tendon. Magnetic resonance imaging evaluation. Am J Orthop (Belle Mead NJ). 1996;25:314, 8–23.

    Google Scholar 

  27. Slatis P, Aalto K. Medial dislocation of the tendon of the long head of the biceps brachii. Acta Orthop Scand. 1979;50:73–7.

    Article  CAS  PubMed  Google Scholar 

  28. Leroux JL, Thomas E, Bonnel F, et al. Diagnostic value of clinical tests for shoulder impingement syndrome. Rev Rhum Engl Ed. 1995;62:423–8.

    CAS  PubMed  Google Scholar 

  29. Walch G, Boulahia A, Calderone S, et al. The ‘dropping’ and ‘hornblower’s’ signs in evaluation of rotator-cuff tears. J Bone Joint Surg. 1998;80:624–8.

    Article  CAS  Google Scholar 

  30. Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg. 1991;73:389–94.

    CAS  Google Scholar 

  31. Gerber C, Hersche O, Farron A. Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am. 1996;78:1015–23.

    Article  CAS  PubMed  Google Scholar 

  32. Tokish JM, Decker MJ, Ellis HB, et al. The belly-press test for the physical examination of the subscapularis muscle: electromyographic validation and comparison to the lift-off test. J Shoulder Elbow Surg. 2003;12:427–30.

    Article  PubMed  Google Scholar 

  33. Kim SH, Ha KI, Ahn JH, et al. Biceps load test II: a clinical test for SLAP lesions of the shoulder. Arthroscopy. 2001;17:160–4.

    Article  CAS  PubMed  Google Scholar 

  34. Kim SH, Ha KI, Han KY. Biceps load test: a clinical test for superior labrum anterior and posterior lesions in shoulders with recurrent anterior dislocations. Am J Sports Med. 1999;27:300–3.

    Article  CAS  PubMed  Google Scholar 

  35. Hanchard NC, Lenza M, Handoll HH, et al. Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement. Cochrane Database Syst Rev. 2013;4:CD007427.

    Google Scholar 

  36. Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med. 1980;8:151–8.

    Article  CAS  PubMed  Google Scholar 

  37. Michener LA, Walsworth MK, Doukas WC, et al. Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Arch Phys Med Rehabil. 2009;90:1898–903.

    Article  PubMed  Google Scholar 

  38. Hughes P. The Neer sign and Hawkins-Kennedy test for shoulder impingement. J Physiother. 2011;57:260.

    Article  PubMed  Google Scholar 

  39. Barber FA, Field LD, Ryu RKN. Biceps tendon and superior labrum injuries: decision-making. J Bone Joint Surg. 2007;89:1844–55.

    Article  PubMed  Google Scholar 

  40. Tallia AF, Cardone DA. Diagnostic and therapeutic injection of the shoulder region. Am Fam Physician. 2003;67:1271–8.

    PubMed  Google Scholar 

  41. Huang S-W, Wang W-T. Quantitative diagnostic method for biceps long head tendinitis by using ultrasound. Sci World J. 2013;2013:7.

    Google Scholar 

  42. Nho SJ, Strauss EJ, Lenart BA, et al. Long head of the biceps tendinopathy: diagnosis and management. J Am Acad Orthop Surg. 2010;18:645–56.

    Article  PubMed  Google Scholar 

  43. Mohtadi NG, Vellet AD, Clark ML, et al. A prospective, double-blind comparison of magnetic resonance imaging and arthroscopy in the evaluation of patients presenting with shoulder pain. J Shoulder Elbow Surg. 2004;13:258–65.

    Article  PubMed  Google Scholar 

  44. Taylor SA, Newman AM, Nguyen J, et al. Magnetic resonance imaging currently fails to fully evaluate the biceps-labrum complex and bicipital tunnel. Arthroscopy. 2016;32:238–44.

    Article  PubMed  Google Scholar 

  45. Zanetti M, Weishaupt D, Gerber C, et al. Tendinopathy and rupture of the tendon of the long head of the biceps brachii muscle: evaluation with MR arthrography. Am J Roentgenol. 1998;170:1557–61.

    Article  CAS  Google Scholar 

  46. Pfirrmann CWA, Zanetti M, Weishaupt D, et al. Subscapularis tendon tears: detection and grading at MR arthrography. Radiology. 1999;213:709–14.

    Article  CAS  PubMed  Google Scholar 

  47. Snyder SJ, Karzel RP, Del Pizzo W, et al. SLAP lesions of the shoulder. Arthroscopy. 1990;6:274–9.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  49. Mazzocca AD, Rios CG, Romeo AA, et al. Subpectoral biceps tenodesis with interference screw fixation. Arthroscopy. 2005;21:896.

    PubMed  Google Scholar 

  50. Messina C, Banfi G, Orlandi D, et al. Ultrasound-guided interventional procedures around the shoulder. Br J Radiol. 2016;89:20150372.

    Article  PubMed  Google Scholar 

  51. Mazzocca AD, Romeo AA. Arthroscopic biceps tenodesis in the beach chair position. Oper Tech Sports Med. 2003;11:6–14.

    Article  Google Scholar 

  52. Sethi PM, Rajaram A, Beitzel K, et al. Biomechanical performance of subpectoral biceps tenodesis: a comparison of interference screw fixation, cortical button fixation, and interference screw diameter. J Shoulder Elbow Surg. 2013;22:451–7.

    Article  PubMed  Google Scholar 

  53. Kelly AM, Drakos MC, Fealy S, et al. Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results. Am J Sports Med. 2005;33:208–13.

    Article  PubMed  Google Scholar 

  54. Romeo AA, Mazzocca AD, Tauro JC. Arthroscopic biceps tenodesis. Arthroscopy. 2004;20:206–13.

    Article  PubMed  Google Scholar 

  55. Lo IKY, Burkhart SS. Arthroscopic biceps tenodesis using a bioabsorbable interference screw. Arthroscopy. 2004;20:85–95.

    Article  PubMed  Google Scholar 

  56. Provencher MT, LeClere LE, Romeo AA. Subpectoral biceps tenodesis. Sports Med Arthrosc Rev. 2008;16:170–6.

    Article  Google Scholar 

  57. Gombera MM, Kahlenberg CA, Nair R, et al. All-arthroscopic suprapectoral versus open subpectoral tenodesis of the long head of the biceps brachii. Am J Sports Med. 2015;43:1077–83.

    Article  PubMed  Google Scholar 

  58. Brady PC, Narbona P, Adams CR, et al. Arthroscopic proximal biceps tenodesis at the articular margin: evaluation of outcomes, complications, and revision rate. Arthroscopy. 2015;31:470–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Tel Aviv Soursky Medical Center and the Sackler Faculty of Medicine at Tel Aviv University, Tel Aviv, Israel

    Zachary T. Sharfman M.D., Eyal Amar M.D. & Ehud Rath M.D.

  2. Department of Orthopaedic Surgery, Assaf Harofe Medical Center and the Sackler Faculty of Medicine, Tzrifin, Israel

    Ran Atzmon M.D.

Authors
  1. Zachary T. Sharfman M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ran Atzmon M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eyal Amar M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ehud Rath M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ehud Rath M.D. .

Editor information

Editors and Affiliations

  1. Orthopaedics and Traumatology Department, Hacettepe University, Ankara, Turkey

    Gazi Huri

  2. Department of Orthopedic Surgery, Division of Sports Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Nikolaos K. Paschos

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Sharfman, Z.T., Atzmon, R., Amar, E., Rath, E. (2017). Anatomy, Assesment, and Surgery of the Biceps Tendon. In: Huri, G., Paschos, N. (eds) The Shoulder. Orthopaedic Study Guide Series. Springer, Cham. https://doi.org/10.1007/978-3-319-51979-1_26

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-51979-1_26

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-51977-7

  • Online ISBN: 978-3-319-51979-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation