Rupture Long Head Biceps: Difference between revisions

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The M. biceps brachii has 2 parts: The long head and the short head. The long head originates at the tuberculum supraglenoidale scapulae and is attached to the dorsal aspect of the tuberositas radii.[3]  
The M. biceps brachii has 2 parts: The long head and the short head. The long head originates at the tuberculum supraglenoidale scapulae and is attached to the dorsal aspect of the tuberositas radii.[3]  


The long head biceps 
starts from the tuberculum subraglenoidale with an intra-articular part. The part passes over the humeral head and then follows the bicipital groove distal to the glenohumeral joint. [8]
The long head biceps 
starts from the tuberculum subraglenoidale with an intra-articular part. The part passes over the humeral head and then follows the bicipital groove distal to the glenohumeral joint. [8]  


<br>There is a strong evidence that the short head is used as more powerful elbow flexor, while the long head is more used as a powerful supinator.[4]
<br>There is a strong evidence that the short head is used as more powerful elbow flexor, while the long head is more used as a powerful supinator.[4]  


Both parts of the tendon are different in shape. The intra-articular part is wide and flat. The extra-articular part is rounder and smaller. [8]<br>The articular portion of the Long head Biceps is irrigated by the anterior circumflex artery. [8]<br>The distal part of LHB is fibrocartilaginous and avascular. The part most vascularized is the proximal tendon. [8]<br>A soft-tissue stabilizes the extra-articular LHB when it enters the bicipital groove en this is built by fibers of the coracohumeral ligament, superior glenohumeral ligament and parts of the subscapularis tendon.[8]<br><br>
Both parts of the tendon are different in shape. The intra-articular part is wide and flat. The extra-articular part is rounder and smaller. [8]<br>The articular portion of the Long head Biceps is irrigated by the anterior circumflex artery. [8]<br>The distal part of LHB is fibrocartilaginous and avascular. The part most vascularized is the proximal tendon. [8]<br>A soft-tissue stabilizes the extra-articular LHB when it enters the bicipital groove en this is built by fibers of the coracohumeral ligament, superior glenohumeral ligament and parts of the subscapularis tendon.[8]<br><br>

Revision as of 11:27, 22 May 2013

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Search Strategy[edit | edit source]

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Search words:

- long head biceps rupture
- long head biceps tendon
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Definition/Description[edit | edit source]

Rupture of the biceps tendon often occurs after a sudden contraction of the biceps with resistance to flexion and supination of the forearm. Also intrinsic degeneration of the tendon release and frictional wear of the tendon belly may have an impact.This intrinsic degeneration is caused by improper training or fatigue, inordinate stresses can be placed on the biceps as it attempts to compensate for other muscles. This can lead to attrition and failure, either within the tendon substance or at its origin. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

The long head of the biceps has several functions like dynamic stabilizer of the glenohumeral joint and a depressor of the humeral headCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Clinically Relevant Anatomy[edit | edit source]

The M. biceps brachii has 2 parts: The long head and the short head. The long head originates at the tuberculum supraglenoidale scapulae and is attached to the dorsal aspect of the tuberositas radii.[3]

The long head biceps 
starts from the tuberculum subraglenoidale with an intra-articular part. The part passes over the humeral head and then follows the bicipital groove distal to the glenohumeral joint. [8]


There is a strong evidence that the short head is used as more powerful elbow flexor, while the long head is more used as a powerful supinator.[4]

Both parts of the tendon are different in shape. The intra-articular part is wide and flat. The extra-articular part is rounder and smaller. [8]
The articular portion of the Long head Biceps is irrigated by the anterior circumflex artery. [8]
The distal part of LHB is fibrocartilaginous and avascular. The part most vascularized is the proximal tendon. [8]
A soft-tissue stabilizes the extra-articular LHB when it enters the bicipital groove en this is built by fibers of the coracohumeral ligament, superior glenohumeral ligament and parts of the subscapularis tendon.[8]

Epidemiology /Etiology[edit | edit source]

Biceps rupture mainly occurs in men between 40 and 60 years who already have a history of shoulder pain. Often this happens after lifting heavy objects.
Also younger men can have this injury but usually after a traumatic fall, heavy weightlifting or consistently sport activities such as snowboarding, soccer, ... [1] [2]

Characteristics/Clinical Presentation[edit | edit source]

Some patients hear a pop at the time of the trauma, others feel a sudden pain in the anterior shoulder. [3] [4]
If there is a rupture of the distal biceps tendon, a Popeye deformity can be seen.[5]

Differential Diagnosis[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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Examination[edit | edit source]

MRI findings in two planes, axial and parasagittal, is required to diagnose accurate a rupture of the biceps tendon.[6]

Medical Management
[edit | edit source]

There is no consensus about surgical repair.

  • Generally they do surgery for young, athletic patients or patients who needs maximum supination strength.
    -> Patients lose up to 20% of supination strength but there is rarely impact on ADL.
  • Non-operative management is considered appropriate for older patients or patients who do not require a high level of supination strength.[7]

Physical Therapy Management
[edit | edit source]

• without surgery:
- we can do mobilizations
- control swelling by cold modalities such as cold packs, ice massage
- against inflammation: NSAIDs except for contraindications
- Preserving ROM:

       *Codman pendulum exercises

       *Functional exercises


• After surgery:
- 10 - 14d: soft sling + light exercises for ROM
- 14d - 6 to 8w: functional exercises using pulleys or therapy bands
- after 6 à 8w: moderate loading may be tolerated but heavy loading is prohibited for the first months. [8]

Key Research[edit | edit source]

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Resources
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Clinical Bottom Line[edit | edit source]

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Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

  1. ↑ QUACH TONY, JAZAYERI REZA, SHERMAN ORRIN H., et al;, ‘Distal biceps tendon injuries. Current treatment options.’, Bulletin of the NYU hospital for joint diseases, 2010, 68 (2):103-111
  2. ↑ GARY L BRANCH, ‘biceps rupture’, medscape reference, 2009
  3. ↑ QUACH TONY, JAZAYERI REZA, SHERMAN ORRIN H., et al;, ‘Distal biceps tendon injuries. Current treatment options.’, Bulletin of the NYU hospital for joint diseases, 2010, 68 (2):103-111
  4. ↑ GARY L BRANCH, ‘biceps rupture’, medscape reference, 2009
  5. ↑ QUACH TONY, JAZAYERI REZA, SHERMAN ORRIN H., et al;, ‘Distal biceps tendon injuries. Current treatment options.’, Bulletin of the NYU hospital for joint diseases, 2010, 68 (2):103-111
  6. ↑ ZANETTI MARCO, WEISHAUPT DOMINIK, GERBER CHRISTIAN, HODLER JUERG, ‘tendinopathy and rupture of the tendon of the long head of the biceps brachii muscle: evaluation with MR arthrography, AJR, 1998, 170:1557-1561
  7. ↑ GARY L BRANCH, ‘biceps rupture’, medscape reference, 2009
  8. ↑ GARY L BRANCH, ‘biceps rupture’, medscape reference, 2009

[1] 

  1. ↑ GURMINA STEFANO, CARBONE STEFANO, PERUGIA DARIO et al, ‘Rupture of the long head biceps tendon treated with tenodesis to the coracoids process. Results at more than 30 years.’, International orthopaedics, 2011, 35:713-716
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