Biceps Tendinopathy: Difference between revisions
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== Clinically Relevant Anatomy<br> == | == Clinically Relevant Anatomy<br> == | ||
The long head of the biceps tendon has a proximal attachment that originates from the supraglenoid tubercle of the scapula and crosses over the head of the humerus within the gleno-humeral joint cavity.<ref name="Moore">Moore K, Dalley A, Agur A. Clinically Oriented Anatomy. 6th ed. Philadelphia, PA: Lippincott Williams &amp; Wilkkins; 2010.</ref> The tendon then descends down the humerus via the intertubercular sulcus while encased in a synovial membrane.<ref name="Moore" /> The transverse humeral ligament helps secure the tendon in place by running from the greater to the lesser tubercle, creating a canal-like structure over the intertubercular groove.<ref name="Moore" /> The distal attachment of the biceps is the radial tuberosity.<ref name="Moore" /> The short head of the biceps begins at the tip of the coracoid process of the scapula and is not usually susceptible to tendinitis.<ref name="Moore" /> <br>Other structures that lie in close contact with the biceps tendon include the anterior and posterior potions of the glenoid labrum, fibers of the subscapularis and supraspinatus tendons, the coracohumeral ligament and the superior glenohumeral ligament.<ref>Bennett WF. Specificity of the Speed's test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy. 1998;14(8):789-796.</ref> The long head of the biceps tendon also acts as a stabilizer for the anterosuperior portion of the rotator cuff, as well as aiding the rotator cuff in maintaining an intimate relationship between the humeral head and the glenoid fossa.<ref>Beall DP, Williamson EE, Ly JQ, et al. Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff. AJR Am J Roentgenol. 2003;180(3):633-639.</ref> The close articulation of the long head of the biceps tendon to other structures around the glenohumeral joint make it likely to be associated with rotator cuff and labral pathologies. | The long head of the biceps tendon has a proximal attachment that originates from the supraglenoid tubercle of the scapula and crosses over the head of the humerus within the gleno-humeral joint cavity.<ref name="Moore">Moore K, Dalley A, Agur A. Clinically Oriented Anatomy. 6th ed. Philadelphia, PA: Lippincott Williams &amp;amp; Wilkkins; 2010.</ref> The tendon then descends down the humerus via the intertubercular sulcus while encased in a synovial membrane.<ref name="Moore" /> The transverse humeral ligament helps secure the tendon in place by running from the greater to the lesser tubercle, creating a canal-like structure over the intertubercular groove.<ref name="Moore" /> The distal attachment of the biceps is the radial tuberosity.<ref name="Moore" /> The short head of the biceps begins at the tip of the coracoid process of the scapula and is not usually susceptible to tendinitis.<ref name="Moore" /> <br>Other structures that lie in close contact with the biceps tendon include the anterior and posterior potions of the glenoid labrum, fibers of the subscapularis and supraspinatus tendons, the coracohumeral ligament and the superior glenohumeral ligament.<ref name="Bennett">Bennett WF. Specificity of the Speed's test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy. 1998;14(8):789-796.</ref> The long head of the biceps tendon also acts as a stabilizer for the anterosuperior portion of the rotator cuff, as well as aiding the rotator cuff in maintaining an intimate relationship between the humeral head and the glenoid fossa.<ref name="Beall">Beall DP, Williamson EE, Ly JQ, et al. Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff. AJR Am J Roentgenol. 2003;180(3):633-639.</ref> The close articulation of the long head of the biceps tendon to other structures around the glenohumeral joint make it likely to be associated with rotator cuff and labral pathologies. | ||
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Clinically Relevant Anatomy
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The long head of the biceps tendon has a proximal attachment that originates from the supraglenoid tubercle of the scapula and crosses over the head of the humerus within the gleno-humeral joint cavity.[1] The tendon then descends down the humerus via the intertubercular sulcus while encased in a synovial membrane.[1] The transverse humeral ligament helps secure the tendon in place by running from the greater to the lesser tubercle, creating a canal-like structure over the intertubercular groove.[1] The distal attachment of the biceps is the radial tuberosity.[1] The short head of the biceps begins at the tip of the coracoid process of the scapula and is not usually susceptible to tendinitis.[1]
Other structures that lie in close contact with the biceps tendon include the anterior and posterior potions of the glenoid labrum, fibers of the subscapularis and supraspinatus tendons, the coracohumeral ligament and the superior glenohumeral ligament.[2] The long head of the biceps tendon also acts as a stabilizer for the anterosuperior portion of the rotator cuff, as well as aiding the rotator cuff in maintaining an intimate relationship between the humeral head and the glenoid fossa.[3] The close articulation of the long head of the biceps tendon to other structures around the glenohumeral joint make it likely to be associated with rotator cuff and labral pathologies.
| Proximal Attachment |
Distal Attachment |
Innervation |
Actions |
| Short head: tip of coracoid process of scapula
Long head: supragleoid tubercle of scapula |
Tuberosity of radius and fascia of forearm via bicipital aponeurosis |
Musculocutaneous nerve (C5, C6, C7) |
Supinates forearm and, when it is supine, flexes forearm; short head resists dislocation of shoulder |
Mechanism of Injury / Pathological Process
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Clinical Presentation[edit | edit source]
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Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Management / Interventions
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Differential Diagnosis
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Differential Diagnosis of Anterior Shoulder Pain[4]:
• Acromioclavicular joint pathology
• Adhesive capsulitis
• Cervical spine pathology
• Glenohumeral arthritis
• Glenohumeral instability
• Humeral head osteonecrosis
• Sub-acromial Impingement syndrome
• Rotator cuff tears
• Superior labrum anterior-posterior lesions (SLAP)
Key Evidence[edit | edit source]
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Resources
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Case Studies[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Moore K, Dalley A, Agur A. Clinically Oriented Anatomy. 6th ed. Philadelphia, PA: Lippincott Williams &amp; Wilkkins; 2010.
- ↑ Bennett WF. Specificity of the Speed's test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy. 1998;14(8):789-796.
- ↑ Beall DP, Williamson EE, Ly JQ, et al. Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff. AJR Am J Roentgenol. 2003;180(3):633-639.
- ↑ Nho SJ, Strauss EJ, Lenart BA, et al. Long head of the biceps tendinopathy: diagnosis and management. J Am Acad Orthop Surg. 2010;18(11):645-656.
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