Skip to main content
SpringerLink
Log in

A comprehensive review of the normal, abnormal, and post-operative MRI appearance of the proximal biceps brachii

  • Review Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

A Correction to this article was published on 16 November 2020

This article has been updated

Abstract

The biceps brachii myotendinous unit, particularly the long head of the biceps tendon and its labral attachment, is a common cause of shoulder and arm pain. Its complex anatomy and normal variations can present a challenge when interpreting MR images. The purpose of this manuscript is to review the proximal biceps anatomy, variants, pathology, and post-operative appearance as seen on MRI. Recent data regarding the accuracy of clinical examination and MRI will be summarized.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19

Similar content being viewed by others

Change history

References

  1. Erickson SJ, Fitzgerald SW, Quinn SF, Carrera GF, Black KP, Lawson TL. Long bicipital tendon of the shoulder: normal anatomy and pathologic findings on MR imaging. Am J Roentgenol. 1992;158(5):1091–6.

    Article  CAS  Google Scholar 

  2. Nakata W, Katou S, Fujita A, Nakata M, Lefor AT, Sugimoto H. Biceps pulley: normal anatomy and associated lesions at MR arthrography. RadioGraphics. 2011;31(3):791–810.

    Article  PubMed  Google Scholar 

  3. Dilisio MF, Neyton L. Comma sign-directed repair of anterosuperior rotator cuff tears. Arthrosc Tech. 2014;3(6):e695–8.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ward AD, Hamarneh G, Schweitzer ME. 3D bicipital groove shape analysis and relationship to tendopathy. J Digit Imaging. 2008;21(2):219–34.

    Article  PubMed  Google Scholar 

  5. Buck FM, Dietrich TJ, Resnick D, Jost B, Pfirrmann CWA. Long biceps tendon: normal position, shape, and orientation in its groove in neutral position and external and internal rotation. Radiology. 2011;261(3):872–81.

    Article  PubMed  Google Scholar 

  6. Crichton JCI, Funk L. The anatomy of the short head of biceps-not a tendon. Int J Shoulder Surg. 2009;3(4):75–9.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gheno R, Zoner CS, Buck FM, Nico MAC, Haghighi P, Trudell DJ, et al. Accessory head of biceps brachii muscle: anatomy, histology, and MRI in cadavers. Am J Roentgenol. 2010;194(1):W80–3.

    Article  Google Scholar 

  8. Moser TP, Cardinal É, Bureau NJ, Guillin R, Lanneville P, Grabs D. The aponeurotic expansion of the supraspinatus tendon: anatomy and prevalence in a series of 150 shoulder MRIs. Skelet Radiol. 2015;44(2):223–31.

    Article  Google Scholar 

  9. McFarland EG, Borade A. Examination of the biceps tendon. Clin Sports Med. 2016;35(1):29–45.

    Article  PubMed  Google Scholar 

  10. Wolf EM, Agrawal V. Transdeltoid palpation (the rent test) in the diagnosis of rotator cuff tears. J Shoulder Elb Surg. 2001;10(5):470–3.

    Article  CAS  Google Scholar 

  11. Gismervik SØ, Drogset JO, Granviken F, Rø M, Leivseth G. Physical examination tests of the shoulder: a systematic review and meta-analysis of diagnostic test performance. BMC Musculoskelet Disord. 2017;18(1):41.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Symanski JS, Subhas N, Babb J, Nicholson J, Gyftopoulos S. Diagnosis of superior labrum anterior-to-posterior tears by using MR imaging and MR arthrography: a systematic review and meta-analysis. Radiology. 2017;285(1):101–13.

    Article  PubMed  Google Scholar 

  13. O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26(5):610–3.

    Article  PubMed  Google Scholar 

  14. Liu SH, Henry MH, Nuccion SL. A prospective evaluation of a new physical examination in predicting glenoid labral tears. Am J Sports Med. 1996;24(6):721–5.

    Article  CAS  PubMed  Google Scholar 

  15. Yergason R. Supination sign. J Bone Joint Surg (Br). 1931;13(160).

  16. Somerville LE, Willits K, Johnson AM, Litchfield R, LeBel M-E, Moro J, et al. Clinical assessment of physical examination maneuvers for superior labral anterior to posterior lesions. Surg J (N Y). 2017;3(4):e154–62.

    Article  Google Scholar 

  17. Mohana-Borges AVR, Chung CB, Resnick D. Superior labral anteroposterior tear: classification and diagnosis on MRI and MR arthrography. Am J Roentgenol. 2003;181(6):1449–62.

    Article  Google Scholar 

  18. Erickson J, Lavery K, Monica J, Gatt C, Dhawan A. Surgical treatment of symptomatic superior labrum anterior-posterior tears in patients older than 40 years: a systematic review. Am J Sports Med. 2015;43(5):1274–82.

    Article  PubMed  Google Scholar 

  19. Abdul-Rassoul H, Defazio M, Curry EJ, Galvin JW, Li X. Return to sport after the surgical treatment of superior labrum anterior to posterior tears: a systematic review. Orthop J Sports Med. 2019;7(5):2325967119841892.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Paoli AR, Gold HT, Mahure SA, Mai DH, Agten CA, Rokito AS, et al. Treatment for symptomatic SLAP tears in middle-aged patients comparing repair, biceps tenodesis, and nonoperative approaches: a cost-effectiveness analysis. Arthroscopy. 2018;34(7):2019–29.

    Article  PubMed  Google Scholar 

  21. Churgay CA. Diagnosis and treatment of biceps tendinitis and tendinosis. Am Fam Physician. 2009;80(5):470–6.

    PubMed  Google Scholar 

  22. 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 Elb Surg. 2004;13(3):249–57.

    Article  Google Scholar 

  23. Burke CJ, Mahanty SR, Pham H, Hoda S, Babb JS, Gyftopoulos S, et al. MRI, arthroscopic and histopathologic cross correlation in biceps tenodesis specimens with emphasis on the normal appearing proximal tendon. Clin Imaging. 2019;54:126–32.

    Article  PubMed  Google Scholar 

  24. Nho SJ, Strauss EJ, Lenart BA, Provencher MT, Mazzocca AD, Verma NN, et al. Long head of the biceps tendinopathy: diagnosis and management. J Am Acad Orthop Surg. 2010;18(11):645–56.

    Article  PubMed  Google Scholar 

  25. Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S. Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elb Surg. 2004;13(1):5–12.

    Article  Google Scholar 

  26. Motley GS, Guengerich B, Schuller T, Turbyfill A. The ramp test: an arthroscopic technique for confirming intra-articular subluxation and instability of the long head of the biceps tendon within the shoulder. Arthrosc Tech. 2018;7(4):e327–30.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Baptista E, Malavolta EA, Gracitelli MEC, Alvarenga D, Bordalo-Rodrigues M, Ferreira Neto AA, et al. Diagnostic accuracy of MRI for detection of tears and instability of proximal long head of biceps tendon: an evaluation of 100 shoulders compared with arthroscopy. Skelet Radiol. 2019;48(11):1723–33.

    Article  Google Scholar 

  28. O’Brien SJ, Shorey M, Taylor SA, Dines JS, Potter HG, Nguyen J. The role of MRI in diagnosing biceps chondromalacia. Orthop J Sports Med. 2015;3(7 suppl2):2325967115S2325900057.

    Google Scholar 

  29. Sistermann R. The biceps tendon footprint. Acta Orthop. 2005;76(2):237–40.

    Article  PubMed  Google Scholar 

  30. Borrero CG, Costello J, Bertolet M, Vyas D. Effect of patient age on accuracy of primary MRI signs of long head of biceps tearing and instability in the shoulder: an MRI-arthroscopy correlation study. Skelet Radiol. 2018;47(2):203–14.

    Article  Google Scholar 

  31. Kang Y, Lee JW, Ahn JM, Lee E, Kang HS. Instability of the long head of the biceps tendon in patients with rotator cuff tear: evaluation on magnetic resonance arthrography of the shoulder with arthroscopic correlation. Skelet Radiol. 2017;46(10):1335–42.

    Article  Google Scholar 

  32. Lee RW, Choi SJ, Lee MH, Ahn JH, Shin DR, Kang CH, et al. Diagnostic accuracy of 3T conventional shoulder MRI in the detection of the long head of the biceps tendon tears associated with rotator cuff tendon tears. Skelet Radiol. 2016;45(12):1705–15.

    Article  Google Scholar 

  33. Tadros AS, Huang BK, Wymore L, Hoenecke H, Fronek J, Chang EY. Long head of the biceps brachii tendon: unenhanced MRI versus direct MR arthrography. Skelet Radiol. 2015;44(9):1263–72.

    Article  Google Scholar 

  34. Gaskin CM, Anderson MW, Choudhri A, Diduch DR. Focal partial tears of the long head of the biceps brachii tendon at the entrance to the bicipital groove: MR imaging findings, surgical correlation, and clinical significance. Skelet Radiol. 2009;38(10):959–65.

    Article  Google Scholar 

  35. Gumina S, Carbone S, Perugia D, Perugia L, Postacchini F. Rupture of the long head biceps tendon treated with tenodesis to the coracoid process. Results at more than 30 years. Int Orthop. 2011;35(5):713–6.

    Article  PubMed  Google Scholar 

  36. Virk MS, Cole BJ. Proximal biceps tendon and rotator cuff tears. Clin Sports Med. 2016;35(1):153–61.

    Article  PubMed  Google Scholar 

  37. Elser F, Braun S, Dewing CB, Giphart JE, Millett PJ. Anatomy, function, injuries, and treatment of the long head of the biceps brachii tendon. Arthroscopy. 2011;27(4):581–92.

    Article  PubMed  Google Scholar 

  38. Slenker NR, Lawson K, Ciccotti MG, Dodson CC, Cohen SB. Biceps tenotomy versus tenodesis: clinical outcomes. Arthroscopy. 2012;28(4):576–82.

    Article  PubMed  Google Scholar 

  39. Patel KV, Bravman J, Vidal A, Chrisman A, McCarty E. Biceps tenotomy versus tenodesis. Clin Sports Med. 2016;35(1):93–111.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Drs. Scott Mair, Scot Sherwood, and John Payan for contributing their cases.

Author information

Authors and Affiliations

  1. Emory University School of Medicine, Atlanta, GA, USA

    Jeffrey Rosenthal

  2. Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA

    My-Linh Nguyen & Adam D. Singer

  3. Department of Orthopaedics, Emory University Hospital, Atlanta, GA, USA

    Spero Karas, Michael Gottschalk, Charles Daly & Eric Wagner

Authors
  1. Jeffrey Rosenthal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. My-Linh Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Spero Karas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Gottschalk
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Charles Daly
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eric Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Adam D. Singer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adam D. Singer.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Consent

Participants signed consent.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rosenthal, J., Nguyen, ML., Karas, S. et al. A comprehensive review of the normal, abnormal, and post-operative MRI appearance of the proximal biceps brachii. Skeletal Radiol 49, 1333–1344 (2020). https://doi.org/10.1007/s00256-020-03415-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-020-03415-x

Keywords

Search

Navigation