Lesions of the long head biceps tendon (LHB) are frequent causes of shoulder pain and disability. Biceps tenotomy and tenodesis have gained widespread acceptance as effective procedures to manage both isolated LHB pathology and combined lesions of the rotator cuff and biceps-labral complex. The function of the LHB tendon and its role in glenohumeral kinematics presently remain only partially understood because of the difficulty of cadaveric and in vivo biomechanical studies. The purpose of this article is to offer an up-to-date review of the anatomy and biomechanical properties of the LHB and to provide an evidence-based approach to current treatment strategies for LHB disorders.

Anatomy, Function, Injuries, and Treatment of the Long Head of the Biceps Brachii Tendon

Purpose: The purpose of this study was to clarify anatomically and clinically how the subscapularis tendon supports the superior portion of the biceps tendon to the intertubercular groove. Methods: Thirty-three embalmed shoulder girdles were examined to investigate the subscapularis tendon and the pathway of the biceps tendon. In addition, operation records of 435 consecutive arthroscopic rotator cuff repairs were retrospectively reviewed. Results: Anatomically, the superior-most insertion of the subscapularis tendon was located on the upper margin of the lesser tuberosity. In addition, a thin tendinous slip extended from the insertion and attached to the fovea capitis of the humerus. The insertion, the tendinous slip, and the lateral portion of the cranial part of intramuscular tendons were in direct contact with the inferior side of the biceps tendon at its corner portion. The clinical study showed that 27.4% of rotator cuff tears (119/435) had subscapularis tendon tears. In cases with an unstable biceps tendon there was no intact subscapularis tendon. The superior-most insertion of the subscapularis tendon was involved in all transverse tears. Of 29 full-thickness transverse tears, 13 (44.8%) showed intra-articular dislocation. Conclusions: The trochlea-like structure was composed of the superior-most insertion, the tendinous slip, and the lateral portion of the cranial part of intramuscular tendons supporting the biceps tendon. The transverse tear of the subscapularis tendon, which included this trochlea-like structure, often leads to intra-articular dislocation of the biceps tendon. Clinical Relevance: Instability of the biceps tendon should be carefully assessed because it is associated with subscapularis tendon tears at a very high incidence. When we repair a transverse tear of the subscapularis tendon, we should widely fix sufficiently strong tissue to support the biceps tendon on the uppermost margin, not on the anteromedial portion, of the lesser tuberosity.

Subscapularis tendon tear: an anatomic and clinical investigation.

Purpose: The purpose of this study was to evaluate arthroscopically the frequency and type of instability of the long head of the biceps (LHB) tendon in patients undergoing rotator cuff repair. Methods: In 200 consecutive patients undergoing arthroscopic rotator cuff repair, LHB instability was assessed statically and dynamically in the anteroposterior direction. In addition, macroscopic lesions of the LHB, as well as lesions of the adjacent rotator cuff tendons, were documented. Results: LHB instability (subluxation or dislocation) was found in 45% of patients, with isolated anterior instability in 16%, isolated posterior instability in 19%, and combined anteroposterior instability in 10%. Whereas LHB subluxations were observed in both directions, dislocations were only seen in anterior LHB instability. Anterior instability was more associated with a subscapularis lesion, whereas posterior instability was more associated with a supraspinatus tear. Lesions of the LHB tendon were strongly associated with LHB instability and the size of the rotator cuff tear. Conclusions: In 200 patients with rotator cuff tears LHB instability could be observed arthroscopically in 45%, with 16% being anterior, 19% being posterior, and 10% being anteroposterior. LHB instability was associated with LHB lesions, with 15% of the LHB tendons showing a normal appearance when unstable versus 70% when stable. Preoperative O'Brien and Speed tests did not correlate with intraoperative observed LHB pathology. The size of the rotator cuff tear could be correlated with the grade of LHB lesion, becoming more significant with augmenting tear size. On the basis of these observations, we created a new arthroscopic classification of LHB instability with respect to the direction and extent of LHB instability, lesions of the LHB, and status of the adjacent rotator cuff tendons. Level of Evidence: Level IV, diagnostic study with poor reference standard.

Anterior and Posterior Instability of the Long Head of the Biceps Tendon in Rotator Cuff Tears: A New Classification Based on Arthroscopic Observations

Disorders of the long head of biceps tendon.

The most common indication for shoulder ultrasonography (US) is the diagnosis of rotator cuff disease. However, there is a spectrum of non-rotator cuff abnormalities that are amenable to US examination, including instability of the biceps tendon, glenohumeral joint, and acromioclavicular joint; arthropathies and bursites (inflammatory diseases, degenerative and infiltrative disorders, infections); nerve entrapment syndromes; and space-occupying lesions. Many of these conditions may be overlooked clinically or can even mimic rotator cuff tears, and US can help redirect the diagnosis if a complete shoulder examination rather than a simple rotator cuff assessment is performed. In addition, US can be remarkably helpful in guiding either needle aspiration procedures or local injection therapy in patients with synovial processes. Although radiography, magnetic resonance (MR) imaging, and computed tomographic and MR arthrography are effective modalities for the evaluation of non-rotator cuff disorders, US is both less costly and less invasive and will likely be used more frequently in this setting as experience increases. Once adequate radiographs have been obtained to exclude apparent bone disorders, high-resolution US should be the first-line imaging modality in the assessment of non-rotator cuff disorders of the shoulder, assuming the study is performed with high-end equipment by an experienced examiner.

https://pubs.rsna.org/doi/pdf/10.1148/rg.232025100

US of the shoulder: non-rotator cuff disorders.

A histoanatomic study of the rotator cuff interval was done in 13 cadaveric specimens to investigate the relation of its ligamentous structures to the long head of the biceps tendon, with a special focus on revealing a stabilizing function. After macroscopic evaluation, the lateral half of the rotator cuff interval capsule was cut into three sections: medial, middle, and lateral. These sections were embedded in methacrylate, and then serial sections were made and stained for polarized light microscopy. The superior glenohumeral ligament was seen to form a fold having the macroscopic appearance of a U-shaped anterior suspension sling for the long head of the biceps tendon. Microscopic evaluation revealed an important role of the fasciculus obliquus in the roof of this sling. Fibers of the supraspinatus tendon join the posterosuperior part of the sling. The subscapularis tendon is not involved in this suspensory mechanism. As a result of these observations, we determined that the superior glenohumeral ligament and the fasciculus obliquus are the most important ligamentous reinforcements of a stabilizing sling for the long head of the biceps tendon in the rotator cuff interval. Their histologic appearance indicates they function to protect the long head of the biceps against anterior shearing stress. A lesion of this sling might lead to anterior instability of the biceps tendon.

The stabilizing sling for the long head of the biceps tendon in the rotator cuff interval. A histoanatomic study.

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Dirk Boehm

Author Tools

Chat about Author

Papers

The stabilizing sling for the long head of the biceps tendon in the rotator cuff interval. A histoanatomic study.