the superior labrum and supraglenoid tubercle of the scapula.
However, the exact site of tendon origin presents several anatomic
variations with more than 50% being from the posterior labrum
but with unknown clinical relevance
[1]
. Normal variations of the
anterosuperior labrum must be distinguished from pathologic
conditions of the biceps anchor
[2]
. These mainly include a sublabral
foramen, a sublabral foramen with a cord-like middle glenohumeral
ligament and an absent anterosuperior labrum with a cord-like middle
glenohumeral ligament (Buford complex)
[3]
(Figure 1).
The LHBT is divided in an intra-articular and an extra-articular
portion, its normal diameter is about 5-6 mm and the total length
approximately 9 cm
[4]
. However, newer published data show that
its length is dependent on the humeral head size
[5]
. The LHBT exits
the glenohumeral joint through the rotator interval and enters into
the bicipital groove where it is held in place by the biceps refection
pulley or sling proximally and the pectoralis major distally. The
biceps pulley consists of fbers of the subscapularis and supraspinatus
tendons, the coracohumeral ligament (CHL) and the superior
glenohumeral ligament (SGHL)
[6-8]
(Figure 2).
The blood supply of the tendon is mainly from branches of the
brachial artery from the musculotendinous side and osteotendinous
derived vessels from the insertion side. There is a consistent
hypovascular area 1.2 to 3 cm from the tendon origin possibly
explaining the susceptibility of this area to degenerative lesions
[9]
.
The anterior superficial part of the tendon is better vascularized
whereas the lateral, posterior and medial side especially the part of
the tendon adjacent to bone appears avascular
[10]
. In addition a large
network of sensory sympathetic fbers innervates mainly the tendon
origin and may play a signifcant role in the pathogenesis of shoulder
pain
[11]
.
FUNCTION
Despite numerous cadaveric biomechanical, EMG, in vivo
biomechanical and experimental studies the actual functional role of
LHBT remains controversial
[4]
.
Achilleas Boutsiadis, Filon Agathangelidis, Dimitrios Karataglis,
Department of Orthopaedics, General Clinic, Blue Cross, Euromedi-
ca Thessaloniki, Greece
Correspondence to: Dimitrios Karataglis, Department of Or-
thopaedics, General Clinic, Blue Cross, Euromedica Thessaloniki,
Greece
Email: dkarataglis@yahoo.gr
Telephone: +302310304442
Received: August 27, 2014 Revised: October 25, 2014
Accepted: October 30, 2014
Published online: December 23, 2014
ABSTRACT
The tendon of the long head of the biceps is commonly involved in
complex pathology of the glenohumeral joint, producing anterior
shoulder pain and dysfunction. The lesions are classifed according to
their location and to whether they are combined with a rotator cuff tears
or not. In this article we present the anatomy and function of the long
head of biceps tendon and through an extensive review of the literature
we report on the latest trends in the management of it’s pathology
ranging from non-operative to the most novel arthroscopic techniques.
© 2014 ACT. All rights reserved.
Key words: Biceps tendon; Pathology; Treatment
Boutsiadis A, Agathangelidis F, Karataglis D. Current Trends in the
Management of Long Head of Biceps Tendon Pathology; Anatomy,
Function, Origin and Interval Lesions. International Journal of
Orthopaedics 2014; 1(4): 146-154 Available from: URL: http://www.
ghrnet.org/index.php/ijo/article/view/835
ANATOMY
The tendon of the long head of biceps (LHBT) arises from
REVIEW
Current Trends in the Management of Long Head of Biceps
Tendon Pathology; Anatomy, Function, Origin and Interval
Lesions
Achilleas Boutsiadis, Filon Agathangelidis, Dimitrios Karataglis
146
Int Journal of Orthopaedics 2014 December 23 1(4): 146-154
ISSN 2311-5106 (Print), ISSN 2313-1462 (Online)
Online Submissions: http://www.ghrnet.org/index./ijo/
doi:10.6051/j.issn.2311-5106.2014.01.40
© 2014 ACT. All rights reserved.
International Journal of Orthopaedics