Arterial Supply of the Human Long Biceps Tendon

Abstract

The present study deals with the question whether an insufficient vascular supply of certain areas can be made responsible for ruptures in the biceps tendon. The macroscopic and microscopic examination shows that the blood supply of the tendon in the part most prone to ruptures that is in the bicipital groove is guaranteed even in older individuals. It is at least much better than in the intra-articular portion where ruptures are seldom observed. This means that mechanical components such as friction are dominant. The vascular factors seem to play a minor part.

The arterial supply of the long head of biceps tendon: Anatomical study with implications for tendon rupture

“…However, while it is probable that a poor blood supply plays some role, the propensity for ruptures to occur in a certain area of the LHB tendon is likely to be a combination of both vascular and mechanical factors. The studies that emphasize the role of mechanical impingement in the rupture of the LHB tendon largely agree that the lesser tubercle exerts considerable friction on the LHB tendon (Hermann and Steiner, 1990; Ahrens, 2007). One possible mechanism favored by this study is repeated mechanical injury to the tendon followed by poor healing due to an insufficient vascular supply (Chen, 2009).…”

“…Previous studies have not been able to show this classic vascular pattern, with no individual paper identifying a blood supply from all three directions (Lindblom, 1939; Korn and Schunke, 1989; Hermann and Steiner, 1990; Kolts et al, 1994; Determe et al, 1996). The existing studies are split into two main opposing views, those identifying only direct branches to the tendon (Hermann and Steiner, 1990; Determe et al, 1996), and those identifying only a supply from the musculotendinous and osteotendinous junctions (Lindblom, 1939; Korn and Schunke, 1989; Kolts et al, 1994). The current findings add validity to both views, demonstrating an arterial supply from all of these sources is possible.…”

“…The main hypotheses for the predilection for ruptures to occur in a certain area of the LHB tendon revolve around mechanical impingement or insufficient vascular supply (Rathbun and Macnab, 1970; Hermann and Steiner, 1990; Refior and Sowa, 1995; Seiler et al, 1995). While seemingly conclusive evidence for the presence of a hypovascular zone in the LHB tendon has been found (Lindblom, 1939; Rathbun and Macnab, 1970; Kessel, 1986), other studies have emphatically denied such a zone exists (Korn and Schunke, 1989; Hermann and Steiner, 1990), favoring mechanical factors such as friction as an explanation for specific areas of the tendon being prone to rupture. While not discounting the effects of friction, this study confirmed the existence of a zone of hypovascularity covering an area 1.2–3 cm from the tendon origin (Figs.…”

“…The papers that do not mention a musculotendinous or osteotendinous vascular supply, often emphasize the importance of direct arterial branches independently entering the LHB tendon, such as those travelling in a mesotenon (Hermann and Steiner, 1990; Kolts et al, 1994; Determe et al, 1996). Hermann and Steiner (1990) and Kolts et al (1994) were of this view, both stressing the importance of direct branches from the anterior circumflex humeral artery in supplying the proximal LHB tendon. Although this study did identify vessels from the anterior circumflex humeral artery entering the tendon via a mesotenon, this supply was only present in a minority of specimens.…”

“…The long head of biceps (LHB) tendon is one of the most frequently ruptured tendons of the body, yet there is neither general consensus as to the cause of these ruptures nor why certain areas of the tendon are particularly vulnerable to injury. In a theme common to many other frequently ruptured tendons, the main hypotheses for why certain areas of the LHB tendon are prone to rupture revolve around mechanical impingement or an insufficient vascular supply (Rathbun and Macnab, 1970; Hermann and Steiner, 1990; Refior and Sowa, 1995; Seiler et al, 1995). These views are favored because ruptures of the LHB tendon most frequently occur in older populations as part of a long‐term degenerative process in which preceding weakening of the tendon eventually culminates in rupture (Kolts et al, 1994).…”