The long head of biceps at the shoulder: a scoping review

Abstract

Background This review aimed to explore the available literature to update our understanding of the long head of biceps (LHB) at the shoulder. Synthesise our findings to identify emergent themes and knowledge gaps to inform future research and management directions. Methods PubMed, Embase, Cinahl, SportDiscus, CENTRAL, and Web of Science were searched from inception to 31st December 2021. Articles were included if they referenced adult participants > 18 years of age and were written in English. Results 214 articles were included in the final analysis, and results were categorised into six emergent themes: (1) Anatomy - Normal anatomical variation of the biceps from aberrant origins, third and fourth accessory heads, and an absence of the LHB tendon (LHBT) are not necessarily benign, with shoulder pain and instability a commonly reported theme. (2) Function - Bicep’s role in glenohumeral elevation and stability in healthy shoulders is minimal. In contrast, LHB has a more significant role in shoulder stability and humeral head depression in subjects with rotator cuff failure or an absent LHBT. (3) Pathology - There is an association between LHB tendinopathy, rotator cuff disease, LHBT instability and occult rotator cuff tears. Early recruitment and hyperactivity of the LHB in subjects with symptomatic rotator cuff tears and instability suggest a potential compensatory role. (4) Assessment - The limited diagnostic utility of special orthopaedic tests in assessing LHBT pathology was a consistent theme. The utility of magnetic resonance imaging and ultrasound to identify full-thickness tendon tears and instability of the LHBT was moderate to high. However, the utility of clinical tests and imaging may be underestimated due to arthroscopy’s limitations in fully visualising the proximal LHBT. (5) Non-Surgical Management - Ultrasound-guided injections into the biceps sheath show greater accuracy and patient outcomes than blinded injections; however, the entry of injectate into the intraarticular glenohumeral joint may have unwanted complications. (6) Surgical management - For the surgical management of biceps pathology with or without rotator cuff pathology, both biceps tenodesis and tenotomy report similar improvements in pain without any significant adverse effect on strength or function. Tenodesis favoured higher overall constant scores and a lower incidence of Popeye deformity and cramping arm pain, with tenotomy trending to be more cost and time effective. For patients with a healthy LHBT, rotator cuff repair with adjunctive tenodesis or tenotomy fails to provide additional clinical improvements compared to rotator cuff repair in isolation. Conclusions The scoping review highlights the variability of biceps anatomy, which is not necessarily benign and suggests a minimal role of the LHB in shoulder elevation and stability in healthy individuals. In contrast, individuals with rotator cuff tears experience proximal humeral migration and demonstrate hyperactivity of the LHB, suggesting a potential compensation role. The observed prevalence of LHBT pathology with rotator cuff tears is well established; however, the cause-and-effect relationship between LHBT pathology and rotator cuff disease is undetermined. The diagnostic utility of clinical tests and imaging to exclude LHBT pathology may be understated due to the limitations of arthroscopy to visualise the proximal LHBT fully. Rehabilitation programs for the LHB are understudied. Similar post-surgical clinical outcomes are observed for tenodesis and tenotomy for biceps and rotator cuff-related shoulder pain. Subjects undergoing biceps tenodesis are less likely to have cramping arm pain and a Popeye deformity than patients undergoing biceps tenotomy. The significance of routine surgical removal of the LHBT and sequelae on rotator cuff tear progression to failure and long-term shoulder function is unknown, and further research is required. Pre-registration OSF: https://osf.io/erh9m

Surgical Treatment of Patients with Damage to the Ligaments Holding the Long Head of the Biceps (Pulley Lesion) in Combination with Contracture of the Shoulder Joint

“…Аналізуючи англомовну літературу, присвячену хірургічному лікуванню ушкоджень зв'язок, що утримують СДГБ, акцент зводиться до рівня тенодезування та супутнім ушкодженням сухожилків ротаторної манжети плеча [8][9][10][11]. Вирішення питання обмеження рухів у ПС при Pulley Lesion ушкодженнях передається до рук реабілітологів, що на нашу думку збільшує терміни захворювання та має економічні наслідки.…”

Is the Tendon-to-Groove Ratio Associated with Elevated Risk for LHB Tendon Disorders?—A New Approach of Preoperative MR-Graphic Analysis for Targeted Diagnosis of Tendinopathy of the Long Head of Biceps

“…These conditions often manifest as anterior shoulder pain, weakness, and clicking sensations during arm movements. While tendinitis and tenosynovitis typically result from overuse or degeneration, subluxation and dislocation can occur due to instability of the biceps tendon within the intertubercular groove (ITG) [7][8][9][10]. Tears of the LHB tendon may occur acutely due to trauma or as a result of degenerative changes.…”

Arthroscopic Suprapectoral Biceps Tenodesis for Isolated Biceps Tendinopathy: Results From 23 Patients

“…The role of the long head of the biceps tendon (LHB) is not thoroughly understood, and its contribution to shoulder joint kinematics and humeral stability thus remains ambiguous [1]. The function of the LHB has mostly been investigated in cadaveric studies, with most of these studies concluding that the LHB contributes to stabilizing the humeral head in all directions and preventing abnormal translations.…”

“…Furthermore, LHB pathology is often treated with concomitant shoulder joint pathology, which poses possible confounding factors when clinical outcome scores are obtained after surgery [17,18]. The lack of validated specific patient scores for biceps pathology adds further difficulty in assessing LHB pathology-related pain and function [1,3,17,18].…”