Arthroscopy: The Journal of Arthroscopic & Related Surgery
Level V EvidenceAnatomy, Function, Injuries, and Treatment of the Long Head of the Biceps Brachii Tendon
Section snippets
Anatomy
The LHB originates from the supraglenoid tubercle of the scapula with an intra-articular portion that passes over the humeral head before exiting the glenohumeral joint through the bicipital groove.1, 2 The tendon is approximately 5 to 6 mm in diameter and approximately 9 cm in length. The size of the tendon varies, and the intra-articular portion is typically wide and flat whereas the extra-articular portion is both rounder and smaller.3 The anterior circumflex humeral artery provides blood
Function of LHB Tendon
A majority of biomechanical studies investigating the role of the LHB have focused on its contributions to glenohumeral stability, restraining abnormal translations. With few exceptions,9, 10 these studies have relied on cadaveric models to examine this interaction.
LHB Pathologies
The LHB can be a source of shoulder pain or diminished function for various reasons. LHB pathologies include tendinitis, rupture, subluxation or instability, pulley lesions, and SLAP lesions.
Current Treatment Strategies
LHB pathologies can be addressed by nonoperative treatment, reconstructive techniques, and tenodesis/tenotomy.
Conservative treatment of biceps rupture usually results in relatively little functional impairment of the shoulder.28 Research at our institution found no statistical difference at the elbow joint in forearm supination or elbow flexion strength when comparing tenotomy, tenodesis, and control groups.55 Because of the minimal functional sequelae of biceps ruptures in middle-aged and
Conclusions
Biomechanical studies in cadaveric models fail to “recreate the myriad factors that act in synergy to provide glenohumeral stability in vivo.”16 A consistent limitation of cadaveric biomechanical studies is their failure to apply physiologic loads to the LHB. There is no consensus in the literature, and values range from 11 to 55 N. In future studies LHB loading conditions should reflect in vivo muscle activation levels.
The function of the LHB tendon and its role in glenohumeral kinematics
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F.E., S.B., and P.J.M. have received support from Arthrex exceeding $500 related to this research.