The anatomy and histology of the bicipital tunnel of the shoulder

Arthroscopic Suprapectoral and Open Subpectoral Biceps Tenodeses Produce Similar Outcomes: A Randomized Prospective Analysis

“…The surgeon then drills a guidewire in line with and perpendicular to the bicipital tunnel just beneath the inferior border of the pectoralis major tendon. This corresponds to a tenodesis location within zone 3 of the bicipital tunnel as described by Taylor et al 22 (Fig 2). Zone 1 of the bicipital tunnel represents the bony bicipital groove underlying the fibers of the subscapularis; zone 2 is bordered by the distal margin of the subscapularis tendon proximally and the proximal margin of the pectoralis major tendon distally; and zone 3 begins at the proximal margin of the pectoralis major tendon and extends distally to the inferior border ( Fig 2).…”

“…This corresponds to zone 2 of the bicipital tunnel (Fig 2). 22 The surgeon removes the LHBT from the subdeltoid space through the portal and prepares it in a fashion similar to that used with the OSPBT technique. Particularly in larger shoulders, the LHBT cannot be retracted sufficiently to allow whipstitch placement.…”

Editorial Commentary: Aim High or Go Low? Outcomes Are Equivalent for Arthroscopic Suprapectoral and Mini-open Subpectoral Biceps Tenodesis

“…A limited open procedure may still be inherently more susceptible to wound healing complications because of attenuated axillary skin tissue and/or bacterial colonization, but it offers the added benefit of decompression of the tenosynovitis common to zone 2 of the LHBT. 12 Cutibacterium acnes is a culprit in roughly 50% of infections after shoulder procedures and has been a topic of heavy investigation over the past decade. 13 This indolent pathogen inhabits the sebaceous glands around the axilla and can frequently withstand a standard preoperative wash. 13,14 Despite this, the complication rates with BT remain relatively low and are consistently reported to be less than 5%.…”

Editorial Commentary: Using a 70° Arthroscope to Evaluate the Biceps Tendon and Rule Out Bicipital Tunnel Disease Is Better Than Using a 30° Arthroscope… but Still Inadequate

“…T he extra-articular segment of the long head of the biceps tendon and its fibro-osseous enclosure, termed the "bicipital tunnel," 1 has gained recent attention in the literature as a common harbor of pathologic lesions. [1][2][3] Several studies have demonstrated the limits of standard diagnostic arthroscopy to fully evaluate this region. [2][3][4][5] With this in mind, Sheean et al 6 sought to answer a simple yet important question: Can we improve visualization during diagnostic arthroscopy by using a 70 arthroscope?…”