Document Type: RESEARCH PAPER

Authors

1 Department of Orthopaedic Surgery, Division of Shoulder Surgery and Sports Medicine, University of Pittsburgh, UPMC Center for Sports, Pittsburgh, PA, USA Department of Orthopaedic Surgery, Razavi Hospital, Mashhad, Iran

2 Department of Orthopaedic Surgery, Razavi Hospital, Mashhad, Iran

3 Department of Orthopaedic Surgery, Advanced Orthopaedic Centers, Woodbury, NJ, USA

4 Department of Orthopaedic Surgery, Division of Shoulder Surgery and Sports Medicine, University of Pittsburgh, UPMC Center for Sports, Pittsburgh, PA, USA

Abstract

Background: To describe a case series of young adult patients with isolated chronic proximal biceps tendinitis
refractory to conservative care found to have anatomic long head biceps tendon (LHBT) origin variations who underwent
arthroscopic-assisted subpectoral biceps tenodesis.
Methods: Patients were included in this retrospective case series if they met all the following criteria: 1) had an
anomalous origin of the LHBT without any pre-operative or concurrent pathologies at the time of surgery, 2) had nontraumatic
anterior shoulder pain refractory to conservative care for >6 months, 3) pain relief with ultrasound guided
steroid injections into the bicipital tendon sheath, and 4) routine radiographs and MRI-arthrogram demonstrating
no pathology. All patients underwent arthroscopic assisted mini-open subpectoral biceps tenodesis. Pre- and postoperative
active range of motion (ROM), strength, visual analog scale (VAS) for pain, and subjective shoulder values
(SSV) were evaluated. Statistical analysis was done using repeated measure ANOVA.
Results: Seven patients mean age of 18.4 ± 3.5 years old were included in this study. Arthroscopic examination
revealed anomalous origins of the LHBT in all patients with the following distribution: medial to superior labrum (x2),
proximal insertion to the supraspinatus confluent with the superior labrum (x2), insertion into the superior capsular
tissues at the rotator interval (x2), and bifid LHBT (x1). VAS score and SSV were significantly improved at 3 months
(PConclusion: Anomalous origins of the LHBT may be a predisposing factor for chronic biceps tendinitis refractory to
non-operative treatment in young adults. Biceps tenodesis seems to offer improvements in function and pain.
Level of evidence: IV

Keywords

Main Subjects

1. Krupp RJ, Kevern MA, Gaines MD, Kotara S, Singleton
SB. Long head of the biceps tendon pain: differential
diagnosis and treatment. J Orthop Sports Phys Ther.
2009; 39(2):55-70.
2. Longo UG, Loppini M, Marineo G, Khan WS, Maffulli
N, Denaro V. Tendinopathy of the tendon of the long
head of the biceps. Sports Med Arthrosc. 2011;
19(4):321-32.
3. Gaskin CM, Golish SR, Blount KJ, Diduch DR.
Anomalies of the long head of the biceps brachii
tendon: clinical significance, MR arthrographic
findings, and arthroscopic correlation in two patients. Skeletal Radiol. 2007; 36(8):785-9.

4. Richards DP, Schwartz M. Anomalous intraarticular
origin of the long head of biceps brachii. Clin J Sport
Med. 2003; 13(2):122-4.
5. Smith EL, Matzkin EG, Kim DH, Harpstrite JK, Kan
DM. Congenital absence of the long head of the
biceps brachii tendon as a VATER association. Am J
Orthop (Belle Mead NJ). 2002; 31(8):452-4.
6. Hyman JL, Warren RF. Extra-articular origin of biceps
brachii. Arthroscopy. 2001; 17(7):E29.
7. Enad JG. Bifurcate origin of the long head of the
biceps tendon. Arthroscopy. 2004; 20(10):1081-3.

8. Zhang AL, Gates CH, Link TM, Ma CB. Abnormal
origins of the long head of the biceps tendon can
lead to rotator cuff pathology: a report of two cases.
Skeletal Radiol. 2014; 43(11):1621-6.
9. Ghalayini SR, Board TN, Srinivasan MS. Anatomic
variations in the long head of biceps: contribution
to shoulder dysfunction. Arthroscopy. 2007;
23(9):1012-8.
10. Glueck DA, Mair SD, Johnson DL. Shoulder instability
with absence of the long head of the biceps tendon.
Arthroscopy. 2003; 19(7):787-9.
11. Compston A. Aids to the investigation of peripheral
nerve injuries. Medical Research Council: Nerve
Injuries Research Committee. His Majesty’s
Stationery Office: 1942; pp. 48 (iii) and 74 figures
and 7 diagrams; with aids to the examination of the
peripheral nervous system. By Michael O’Brien for the
Guarantors of Brain. Saunders Elsevier: 2010; pp. [8]
64 and 94 Figures. Brain. 2010; 133(10):2838-44.
12. Foad A, Faruqui S. Case report: absence of the long
head of the biceps brachii tendon. Iowa Orthop J.
2016; 36:88-93.
13. Franco JC, Knapp TP, Mandelbaum BR. Congenital
absence of the long head of the biceps tendon. A case
report. J Bone Joint Surg Am. 2005; 87(7):1584-6.
14. Sayeed SA, Shah JP, Collins MS, Dahm DL. Absence of
the long head of the biceps tendon associated with
glenoid dysplasia and posterior labral tear. Clin Anat.
2008; 21(7):728-32.
15. Kim KC, Rhee KJ, Shin HD. A long head of the biceps
tendon confluent with the intra-articular rotator
cuff: arthroscopic and MR arthrographic findings.
Arch Orthop Trauma Surg. 2009; 129(3):311-4.
16. Wittstein J, Lassiter T Jr, Taylor D. Aberrant origin of
the long head of the biceps: a case series. J Shoulder
Elbow Surg. 2012; 21(3):356-60.
17. MacDonald PB. Congenital anomaly of the biceps
tendon and anatomy within the shoulder joint.
Arthroscopy. 1998; 14(7):741-2.
18. Lang JE, Vinson EN, Basamania CJ. Anomalous biceps
tendon insertion into the rotator cable: a case report.
J Surg Orthop Adv. 2008; 17(2):93-5.
19. Pagnani MJ, Deng XH, Warren RF, Torzilli PA, O’Brien
SJ. Role of the long head of the biceps brachii in
glenohumeral stability: a biomechanical study in
cadavera. J Shoulder Elbow Surg. 1996; 5(4):255-62.
20. Warner JJ, McMahon PJ. The role of the long head
of the biceps brachii in superior stability of the
glenohumeral joint. J Bone Joint Surg Am. 1995;
77(3):366-72.
21. Itoi E, Motzkin NE, Morrey BF, An KN. Stabilizing
function of the long head of the biceps in the
hanging arm position. J Shoulder Elbow Surg. 1994;
3(3):135-42.