International Orthopaedics

, Volume 42, Issue 6, pp 1347–1355 | Cite as

Diagnosis of long head of biceps tendinopathy in rotator cuff tear patients: correlation of imaging and arthroscopy data

  • Morgane Rol
  • Luc Favard
  • Julien Berhouet
Original Paper



The goal of this prospective study was to assess the reliability of pre-operative cross-sectional imaging for the diagnosis of long head of biceps (LHB) tendinopathy in patients with a rotator cuff tear.


Cross-sectional imaging with MRI or CT arthrography data from 25 patients operated upon because of a rotator cuff tear between 1 October 2015 and 1 April 2016 was analysed by one experienced orthopaedic surgeon, one experienced radiologist and one orthopaedic resident. The analysis consisted of determining whether the LHB was present, the extrinsic tendon abnormalities (dislocation, tendon coverage) and intrinsic abnormalities (fraying, inflammation, degeneration). These findings were then compared to intra-operative arthroscopy findings, which were used as the benchmark. The interobserver correlation between the three different examiners for the cross-sectional imaging analysis as well as the correlation between the imaging and arthroscopy data were determined.


The correlation between the imaging and arthroscopy data was the highest (80%) for the determination of LHB dislocation from the bicipital groove. The other diagnostic elements (subluxation, coverage and tendon degeneration) were difficult to discern with preoperative imaging, and correlated poorly with the arthroscopy findings (45% to 65%). The interobserver correlation was moderate to strong for the diagnosis of extrinsic tendon abnormalities. It was low to moderate for intrinsic abnormalities.


Except for LHB dislocation, pre-operative imaging is not sufficient to make a reliable diagnosis of LHB tendinopathy. Arthroscopy remains the gold standard for the management of LHB tendinopathy, as diagnosed intra-operatively.


Long head of biceps Rotator cuff tear Cross-sectional imaging Arthroscopy 



The authors are grateful to Joanne Archambault, PhD for her editorial assistance.

Compliance with ethical standards

Conflict of interest

Morgane Rol and Julien Berhouet: none.

Luc Favard: Tornier® consultant.


  1. 1.
    Ahrens PM, Boileau P (2007) The long head of biceps and associated tendinopathy. J Bone Joint Surg Br Vol 89(8):1001–1009. CrossRefGoogle Scholar
  2. 2.
    Jordan RW, Saithna A (2015) Physical examination tests and imaging studies based on arthroscopic assessment of the long head of biceps tendon are invalid. Knee Surg Sports Traumatol Arthrosc.
  3. 3.
    Taylor SA, Newman AM, Nguyen J, Fabricant PD, Baret NJ, Shorey M, Ramkumar P, O'Brien SJ (2016) Magnetic resonance imaging currently fails to fully evaluate the biceps-Labrum complex and Bicipital tunnel. Arthroscopy 32(2):238–244. CrossRefPubMedGoogle Scholar
  4. 4.
    Boileau P, Baque F, Valerio L, Ahrens P, Chuinard C, Trojani C (2007) Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am 89(4):747–757. PubMedCrossRefGoogle Scholar
  5. 5.
    Nourissat G, Tribot-Laspiere Q, Aim F, Radier C (2014) Contribution of MRI and CT arthrography to the diagnosis of intra-articular tendinopathy of the long head of the biceps. Orthop Traumatol Surg Res 100(8 Suppl):S391–S394. CrossRefPubMedGoogle Scholar
  6. 6.
    Skendzel JG, Jacobson JA, Carpenter JE, Miller BS (2011) Long head of biceps brachii tendon evaluation: accuracy of preoperative ultrasound. AJR Am J Roentgenol 197(4):942–948. CrossRefPubMedGoogle Scholar
  7. 7.
    De Maeseneer M, Boulet C, Pouliart N, Kichouh M, Buls N, Verhelle F, De Mey J, Shahabpour M (2012) Assessment of the long head of the biceps tendon of the shoulder with 3T magnetic resonance arthrography and CT arthrography. Eur J Radiol 81(5):934–939. CrossRefPubMedGoogle Scholar
  8. 8.
    Tadros AS, Huang BK, Wymore L, Hoenecke H, Fronek J, Chang EY (2015) Long head of the biceps brachii tendon: unenhanced MRI versus direct MR arthrography. Skelet Radiol 44(9):1263–1272. CrossRefGoogle Scholar
  9. 9.
    Teefey SA, Rubin DA, Middleton WD, Hildebolt CF, Leibold RA, Yamaguchi K (2004) Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg Am 86-A(4):708–716CrossRefPubMedGoogle Scholar
  10. 10.
    Taylor SA, Khair MM, Gulotta LV, Pearle AD, Baret NJ, Newman AM, Dy CJ, O'Brien SJ (2015) Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex. Arthroscopy 31(2):215–224. CrossRefPubMedGoogle Scholar
  11. 11.
    Szabo I, Boileau P, Walch G (2008) The proximal biceps as a pain generator and results of tenotomy. Sports Med Arthrosc Rev 16(3):180–186. CrossRefPubMedGoogle Scholar
  12. 12.
    Zanetti M, Weishaupt D, Gerber C, Hodler J (1998) Tendinopathy and rupture of the tendon of the long head of the biceps brachii muscle: evaluation with MR arthrography. AJR Am J Roentgenol 170(6):1557–1561. CrossRefPubMedGoogle Scholar
  13. 13.
    Mohtadi NG, Vellet AD, Clark ML, Hollinshead RM, Sasyniuk TM, Fick GH, Burton PJ (2004) A prospective, double-blind comparison of magnetic resonance imaging and arthroscopy in the evaluation of patients presenting with shoulder pain. J Shoulder Elb Surg 13(3):258–265. CrossRefGoogle Scholar
  14. 14.
    Armstrong A, Teefey SA, Wu T, Clark AM, Middleton WD, Yamaguchi K, Galatz LM (2006) The efficacy of ultrasound in the diagnosis of long head of the biceps tendon pathology. J Shoulder Elb Surg 15(1):7–11. CrossRefGoogle Scholar
  15. 15.
    Drolet P, Martineau A, Lacroix R, Roy JS (2016) Reliability of ultrasound evaluation of the long head of the biceps tendon. J Rehabil Med 48(6):554–558. CrossRefPubMedGoogle Scholar
  16. 16.
    Razmjou H, Fournier-Gosselin S, Christakis M, Pennings A, ElMaraghy A, Holtby R (2016) Accuracy of magnetic resonance imaging in detecting biceps pathology in patients with rotator cuff disorders: comparison with arthroscopy. J Shoulder Elb Surg 25(1):38–44. CrossRefGoogle Scholar
  17. 17.
    Malavolta EA, Assuncao JH, Guglielmetti CL, de Souza FF, Gracitelli ME, Ferreira Neto AA (2015) Accuracy of preoperative MRI in the diagnosis of disorders of the long head of the biceps tendon. Eur J Radiol 84(11):2250–2254. CrossRefPubMedGoogle Scholar
  18. 18.
    Charousset C, Bellaiche L, Duranthon LD, Grimberg J (2005) Accuracy of CT arthrography in the assessment of tears of the rotator cuff. J Bone Joint Surg Br Vol 87(6):824–828. CrossRefGoogle Scholar
  19. 19.
    Boileau P, Maynou C, Balestro JC, Brassart N, Clavert P, Cotten A, Gosselin O, Lespagnol F, Jacquot N, Walch G (2007) Long head of the biceps pathology. Rev Chir Orthop Reparatrice Appar Mot 93(8 Suppl):5S19–5S53PubMedGoogle Scholar
  20. 20.
    Festa A, Allert J, Issa K, Tasto JP, Myer JJ (2014) Visualization of the extra-articular portion of the long head of the biceps tendon during intra-articular shoulder arthroscopy. Arthroscopy 30(11):1413–1417. CrossRefPubMedGoogle Scholar
  21. 21.
    Rosas S, Krill MK, Amoo-Achampong K, Kwon K, Nwachukwu BU, McCormick F (2017) A practical, evidence-based, comprehensive (PEC) physical examination for diagnosing pathology of the long head of the biceps. J Shoulder Elb Surg 26(8):1484–1492. CrossRefGoogle Scholar
  22. 22.
    Taylor SA, Newman AM, Dawson C, Gallagher KA, Bowers A, Nguyen J, Fabricant PD, O'Brien SJ (2017) The "3-pack" examination is critical for comprehensive evaluation of the biceps-Labrum complex and the Bicipital tunnel: a prospective study. Arthroscopy 33(1):28–38. CrossRefPubMedGoogle Scholar
  23. 23.
    Sandrey MA (2013) Special physical examination tests for superior labrum anterior-posterior shoulder tears: an examination of clinical usefulness. J Athl Train 48(6):856–858.
  24. 24.
    Gartsman GM (1996) Arthroscopic assessment of rotator cuff tear reparability. Arthroscopy 12(5):546–549CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  1. 1.Université François Rabelais de Tours – Faculté de Médecine de Tours - CHRU Trousseau Service d’Orthopédie TraumatologieChambray-les-ToursFrance
  2. 2.Service Chirurgie Orthopédique et TraumatologiqueHôpital TrousseauToursFrance
  3. 3.Université François Rabelais de Tours – Laboratoire d’Informatique EA 6300-ERL-CNRS 6305, Ecole Polytechnique Universitaire de ToursToursFrance

Personalised recommendations