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Biceps Tendon

Key Points

The long head of the biceps (LHB) originates at and around the supraglenoid tubercle. Although it is intra-articular, it is extrasynovial.
Although acute ruptures of the LHB do occur, LHB ruptures are more commonly the result of chronic biceps tendonitis.

There is such a close association between subacromial impingement and biceps tendonitis that the two conditions have closely overlapping symptoms. They can be difficult to distinguish and more often than not occur in tandem.
The hallmark of biceps tendon related pathology is point tenderness in the bicipital groove.

Given the close relationship between biceps tendon pathology and concomitant subacromial impingement and/or rotator cuff tear, it is important to examine the remainder of the shoulder. Specific tests for range of motion, impingement, rotator cuff integrity, and instability should be performed.

Ultrasound and arthrography are equally effective for the diagnosis of biceps tendon and rotator cuff problems, but ultrasound is superior when evaluating the biceps tendon.
Complications of the biceps tenotomy primarily involve the anticipated 21% risk of a “Popeye” deformity of the biceps muscle as it retracts distally. Arthroscopic biceps tenotomy is otherwise a relatively safe procedure with very minor risks of infection, blood clots, or neurovascular injury. Biceps tenodesis may be appropriate for younger, more active patients to maximize shoulder and elbow function.

The long head of the biceps (LHB) tendon … what does it do? What symptoms does it cause? What is the etiology of its pathology? What is the best treatment of biceps associated disorders? These are just a few of the questions concerning the biceps tendon for which opinions are abundant but firm conclusions are elusive. In our understanding of the shoulder, the LHB is still somewhat of an enigma. There are many beliefs and a plethora of data which provide much information but little clarity on the biceps tendon.

This chapter will attempt to provide a comprehensive overview regarding the biceps tendon. It will discuss both the undisputed aspects such as its anatomy as well as more controversial topics such as its function, pathophysiology, and treatment. The goal is to present a balanced and succinct overview of the biceps tendon and its pathology and treatment.

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