Agenesis of the long head of the biceps brachii tendon: ignored variations of the anatomy and the next tendon to disappear?

Abstract

Bilateral agenesis of the long head of the biceps brachial tendon (LHB) is a very rare variation of the anatomy. We report a case of an 18-year-old man with bilateral agenesis of the long head of the biceps brachii tendon. We present initial findings, radiographical examinations and the follow-up of an unusual entity. Diagnosis of agenesis of the LHB can be challenging especially in cases of traumatic shoulder pain. It is not a very known entity because of its rareness. However, it could be associated with other congenital anomalies. The absence of the LHB is easily ignored in the diagnostic process. Clinical examination should be a pitfall, radiological examination is helpful to confirm the suspicion of LHB absence. MRI is often the first choice, although ultrasonography is cheaper and much easier to access and it is an excellent tool to visualise this anatomic variation with empty or shallow intertubercular groove.

Treatment outcomes of tendinitis of long head of the biceps brachii tendon by different surgeries based on the concept of enhanced recovery after surgery

“…According to major studies, the incidence rate of shoulder deformity increases after LHBT tenotomy compared to that after tenodesis. [ 22 - 24 ] In a recent retrospective study by Godenèche et al,[ 25 ] during the 10-year follow-up, no deformity occurred at all after LHBT tenodesis or tenotomy. A total of 11.4% of patients undergoing tenodesis suffer from Popeye deformity, possibly as the biceps tendon has insufficient tension or the tendon is in a position where the biceps tendon is over-relaxed.…”

Biceps tendon autograft augmentation for rotator cuff and instability procedures: a narrative review

“…Anatomical variations of LHBT, affecting approximately 6–10% of the studied population ( 8 ), typically encompass aberrant tendon origin, supernumerary accessory heads, intra-articular tendon mobility, and tendon absence. The association between these variations and patient-related shoulder manifestations such as instability, pain, or diminished shoulder function is rather uncertain due to the predominance of case studies in current literature ( 9 , 10 ). There is only one study with a larger population that identified a correlation between proximal LHBT tendon anatomical variations (sublabral foramen, cord-like middle glenohumeral ligament, or Buford complex) and an increase in passive internal rotation at a 90° abduction ( P = 0.046), leading to anterosuperior labral fraying ( P = 0.000) ( 11 ).…”