Biceps brachii muscle

The biceps brachii muscle (also known simply as biceps) is a two-headed muscle in the anterior compartment of the arm that flexes at the elbow and supinates the forearm.

Summary

• origin

  • short head: coracoid process of the scapula

  • long head: supraglenoid tubercle of the scapula

• insertion: radial tuberosity of the proximal radius

• innervation: musculocutaneous nerve

• arterial supply: muscular branches of the brachial artery

• action

  • glenohumeral joint

    • long head:arm abduction

    • short head: arm arm adduction and flexion

  • elbow joint

    • supination of the pronated forearm

    • flexion of the supinated forearm

Gross anatomy

Origin

Given the muscle has two proximal tendons (hence its name), there are two origins:

• the long head originates at the supraglenoid tubercle of the scapula before passing laterally through the rotator cuff interval and and then inferiorly through the intertubercular (bicipital) groove of the proximal humerus.

• the short head tendon is much simpler, originating from the apex of the coracoid process of the scapula, lateral to the origin of the coracobrachialis muscle.

The two muscle bellies remain separate until merging in the distal arm above the elbow joint.

Insertion

The distal insertion of the biceps tendon has two components:

• a bifid tendon descends onto the posterior margin of the radial tuberosity of the proximal radius which is associated with a small bursa to facilitate supination and pronation.

• a bicipital aponeurosis (lacertus fibrosus) that arises from the medial aspect of the tendon before it dives deep towards the radial tuberosity. The aponeurosis spans across the brachial artery and median nerve before inserting onto the antebrachial fascia overlying the flexor muscles.

Innervation

Separate branches from the musculocutaneous nerve (C5,6) supply each muscle belly.

Action

As the muscle has several heads and crosses both the shoulder and elbow joints, the biceps muscle has a variety of actions:

• with the elbow is extended, biceps solely produces elbow flexion

• with any degree of elbow flexion, biceps will produce supination with triceps brachii resisting resisting elbow flexion

• if triceps does not counteract elbow flexion, biceps will produce flexion at both the shoulder and elbow

• biceps can help initiate shoulder abduction if deltoid is weak or paralysed

Overall, these complex movements can be summarised as:

• glenohumeral joint

  • long head: arm arm abduction

  • short head: arm arm adduction and flexion

• elbow joint

  • supination of the pronated forearm

  • flexion of the supinated forearm

Variant anatomy

• duplicated long head of biceps tendon: can mimic longitudinal tear ¹

• bifid/bifurcated insertion: anatomic variant that arises from persistent division between the short head and long head of the distal biceps brachii tendon ³

• accessory head of long head of biceps tendon ⁴

Clinical significance

Brasseur ⁵ describes nine individual zones (from proximal to distal) that should be assessed with ultrasound:

1. glenoid insertion of the long head

2. extension to the upper pole of the head of the humerus

3. rotator interval

4. reflection to the upper bicipital groove

5. bicipital groove

6. upper myotendinous junction

7. lower myotendinous junction

8. dstal tendon(s)

9. distal enthesis

Related pathology

• long head of biceps brachii tendon pathology

  • long head of biceps tendon dislocation