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

https://doi.org/10.1016/j.arthro.2010.10.014Get rights and content

Abstract

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.

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

References (82)

  • W.F. Bennett

    Arthroscopic repair of isolated subscapularis tears: A prospective cohort with 2- to 4-year follow-up

    Arthroscopy

    (2003)
  • C. Gerber et al.

    Impingement of the deep surface of the subscapularis tendon and the reflection pulley on the anterosuperior glenoid rim: A preliminary report

    J Shoulder Elbow Surg

    (2000)
  • S.J. Snyder et al.

    SLAP lesions of the shoulder

    Arthroscopy

    (1990)
  • G.M. Gartsman et al.

    The incidence of glenohumeral joint abnormalities associated with full-thickness, reparable rotator cuff tears

    Arthroscopy

    (1997)
  • S.J. Snyder et al.

    An analysis of 140 injuries to the superior glenoid labrum

    J Shoulder Elbow Surg

    (1995)
  • P.J. Favorito et al.

    Complete arthroscopic examination of the long head of the biceps tendon

    Arthroscopy

    (2001)
  • C. Ruotolo et al.

    Controversial topics in shoulder arthroscopy

    Arthroscopy

    (2002)
  • P. Boileau et al.

    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)
  • T.J. Gill et al.

    Results of biceps tenotomy for treatment of pathology of the long head of the biceps brachii

    J Shoulder Elbow Surg

    (2001)
  • U. Berlemann et al.

    Tenodesis of the long head of biceps brachii in the painful shoulder: Improving results in the long term

    J Shoulder Elbow Surg

    (1995)
  • P. Boileau et al.

    Arthroscopic biceps tenodesis: A new technique using bioabsorbable interference screw fixation

    Arthroscopy

    (2002)
  • G.M. Gartsman et al.

    Arthroscopic biceps tenodesis: Operative technique

    Arthroscopy

    (2000)
  • A.A. Romeo et al.

    Arthroscopic biceps tenodesis

    Arthroscopy

    (2004)
  • A.D. Mazzocca et al.

    Mini open and subpectoral biceps tenodesis

    Oper Tech Sports Med

    (2003)
  • L.C. Sekiya et al.

    Arthroscopic biceps tenodesis using the percutaneous intra-articular transtendon technique

    Arthroscopy

    (2003)
  • N.N. Verma et al.

    Arthroscopic transfer of the long head biceps to the conjoint tendon

    Arthroscopy

    (2005)
  • A.D. Mazzocca et al.

    The biomechanical evaluation of four fixation techniques for proximal biceps tenodesis

    Arthroscopy

    (2005)
  • M. Ozalay et al.

    Mechanical strength of four different biceps tenodesis techniques

    Arthroscopy

    (2005)
  • D.P. Richards et al.

    A biomechanical analysis of two biceps tenodesis fixation techniques

    Arthroscopy

    (2005)
  • S.J. Nho et al.

    Complications associated with subpectoral biceps tenodesis: Low rates of incidence following surgery

    J Shoulder Elbow Surg

    (2010)
  • W.F. Bennett

    Arthroscopic bicipital sheath repair: Two-year follow-up with pulley lesions

    Arthroscopy

    (2004)
  • A.N. Carter et al.

    Proximal biceps tendon rupture: Primarily an injury of middle age

    Phys Sportsmed

    (1999)
  • C.L. Eakin et al.

    Biceps tendon disorders in athletes

    J Am Acad Orthop Surg

    (1999)
  • P.M. Ahrens et al.

    The long head of biceps and associated tendinopathy

    J Bone Joint Surg Br

    (2007)
  • K. Alpantaki et al.

    Sympathetic and sensory neural elements in the tendon of the long head of the biceps

    J Bone Joint Surg Am

    (2005)
  • A. Werner et al.

    The stabilizing sling for the long head of the biceps tendon in the rotator cuff intervalA histoanatomic study

    Am J Sports Med

    (2000)
  • S. Braun 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)
  • J.R. Andrews et al.

    Glenoid labrum tears related to the long head of the biceps

    Am J Sports Med

    (1985)
  • J.J. Warner et al.

    The role of the long head of the biceps brachii in superior stability of the glenohumeral joint

    J Bone Joint Surg Am

    (1995)
  • E. Itoi et al.

    Stabilising function of the biceps in stable and unstable shoulders

    J Bone Joint Surg Br

    (1993)
  • M.W. Rodosky et al.

    The role of the long head of the biceps muscle and superior glenoid labrum in anterior stability of the shoulder

    Am J Sports Med

    (1994)
  • Cited by (199)

    View all citing articles on Scopus

    F.E., S.B., and P.J.M. have received support from Arthrex exceeding $500 related to this research.

    View full text