Long head of biceps tendon
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The long head of the biceps tendon (LHBT) is the proximal tendon of the long head of the biceps muscle andencircles the humeral head on its course. It has an intraarticular extrasynovial and extraarticular portion.
Summary
- location: shoulder
- insertion: supraglenoid tubercle of the scapula and superior labrum
-
blood supply: anterior humeral circumflex artery, brachial and
thoracoacrimialthoracoacromial arteries - innervation: sympathetic fibres
- relations: superior labrum, rotator interval, biceps pulley, pectoralis major insertion
-
function:
stabizerstabilizer of the glenohumeral joint
Gross anatomy
The long head of the biceps tendon hasan intraarticular and extrasynovial portion encircling the anterior aspect of the humeral head covered by synovium from the joint capsule that extends into the bicipital groove. The tendon originates from the superior aspect of the glenoid and superior labrum, courses through the rotator interval beneath the coracohumeral ligament and and through the bicipital groove 1-3.
Function
Functions of the long head biceps tendon include the following 2-4:
- force transmission created by the biceps muscle
- stabilisation of glenohumeral joint especially in the abduction and external rotation
Attachments
The tendon originates from the superior supraglenoid tubercle and superior labrum mostly with predominant contributionscontributions from the posterior labrum or equal contributions from anterior and posterior superior labrum 5.
Its myotendinous junction is at the proximal humerus at the level of the insertion of the pectoralis major tendon muscle2.
Relations and boundaries
Above the humeral head and the long head biceps tendon courses through the rotator interval and is bordered by the structures of the biceps pulley 3:
- coracohumeral ligament superiorly
- superior glenohumeral ligament anteriorly and inferiorly
- supraspinatus tendon posterosuperiorly
- subscapularis tendon anteroinferiorly
Within the bicipital groove, the long head biceps tendon is bordered by the lesser tubercle anteriorly, the greater tubercle posteriorly and covered by the transverse humeral ligament 1.
The distal part and its myotendinous junction isare covered by insertion of the pectoralis major muscle.
Arterial supply
The proximal part of the long head biceps including parts of the bicipital groove appearappears to be mainly supplied from branches of the anterior humeral circumflex artery 6. The further distal portions receive their supply from the brachial and thoracoacromial arteries 4,7.
Innervation
The long head biceps tendon is innervated by sensory sympathetic fibres more so in its proximal portion 3.
Variant anatomy
Anatomical variants include the following 3,8,9:
- congenital absence of the long head biceps tendon
- double or triple tendon with common or separate origin
- adherence to the supraspinatus or joint capsule
- variations in the mesotenon
Radiographic features
The long head biceps tendon can be nicely evaluated on soft tissue-tissue imaging modalities as ultrasound and MRI 3.
Ultrasound
Ultrasound can readily identify the long head biceps tendon in the bicipital groove beneath the transverse humeral ligament usually with a minimal amount of surrounding fluid. From there it can be traced upwards through the rotator interval to its origin at the superior glenoid. It should not be thickened and show any tears or fibre discontinuities – beware of anisotropy 10.
MRI
The long head biceps tendon can be readily seen on MRI of the shoulder as a hypointense string like-like structure encircling the humeral head. It can be affected by the magic angle phenomenon especiallyeffect especially in the curve as it encircles the humeral head and enters the bicipital groove.
Moreover, MRI is able tocan depict most biceps tendon pathologies except for isolated pulley lesions 3.
MR athrographyarthrography
MR athrographyarthrography can be used in the detection of biceps pulley injuries and has been shown to have a high accuracy 11.
Related pathology
The following pathologies can be associated with the long head biceps tendon 1-3:
- biceps tendon degeneration
- long head biceps tendon injury
- SLAP lesions
- biceps pulley injury
- biceps tendon dislocation
-<p>The<strong> long head of biceps tendon (LHBT) </strong>is the proximal tendon of the long head of the biceps muscle and<strong> </strong>encircles the humeral head on its course. It has an intraarticular extrasynovial and extraarticular portion.</p><h4>Summary</h4><p><strong>location:</strong> shoulder</p><p><strong>insertion: </strong>supraglenoid tubercle of the scapula and superior labrum</p><p><strong>blood supply: </strong>anterior humeral circumflex artery, brachial and thoracoacrimial arteries</p><p><strong>innervation: </strong>sympathetic fibres</p><p><strong>relations: </strong>superior labrum, rotator interval, biceps pulley, pectoralis major insertion</p><p><strong>function: </strong>stabizer of the glenohumeral joint</p><h4>Gross anatomy</h4><p>The long head of the biceps tendon has<strong> </strong>an intraarticular and extrasynovial portion encircling the anterior aspect of the humeral head covered by synovium from the joint capsule that extends into the bicipital groove. The tendon originates from the superior aspect of the glenoid and superior labrum, courses through the rotator interval beneath the coracohumeral ligament and and through the bicipital groove <sup>1-3</sup>.</p><h5>Function</h5><p>Functions of the long head biceps tendon include the following <sup>2-4</sup>:</p><p>force transmission created by the biceps muscle</p><p>stabilisation of glenohumeral joint especially in abduction and external rotation</p><h5>Attachments</h5><p>The tendon originates from the superior supraglenoid tubercle and superior labrum mostly with predominant contributions from posterior labrum or equal contributions from anterior and posterior superior labrum <sup>5</sup>.</p><p>Its myotendinous junction is at the proximal humerus at level of the pectoralis major tendon <sup>2</sup>.</p><h5>Relations and boundaries</h5><p>Above the humeral head and the long head biceps tendon is bordered by the structures of the biceps pulley <sup>3</sup>:</p><p>coracohumeral ligament superiorly</p><p>superior glenohumeral ligament anteriorly and inferiorly</p><p>supraspinatus tendon posterosuperiorly</p><p>subscapularis tendon anteroinferiorly</p><p>Within the bicipital groove the long head biceps tendon is bordered by the lesser tubercle anteriorly, the greater tubercle posteriorly and covered by the transverse humeral ligament <sup>1</sup>.</p><p>The distal part and its myotendinous junction is covered by insertion of the pectoralis major muscle.</p><p> </p><p>Arterial supply</p><p>The proximal part of the long head biceps including parts of the bicipital groove appear to be mainly supplied from branches of the anterior humeral circumflex artery <sup>6</sup>. The further distal portions receive their supply from the brachial and thoracoacromial arteries <sup>4,7</sup>.</p><h4>Innervation</h4><p>The long head biceps tendon is innervated by sensory sympathetic fibres more so in its proximal portion <sup>3</sup>.</p><h4>Variant anatomy</h4><p>Anatomical variants include the following <sup>3,8,9</sup>:</p><p>congenital absence of the long head biceps tendon</p><p>double or triple tendon with common or separate origin</p><p>adherence to the supraspinatus or joint capsule</p><p>variations in the mesotenon</p><p> </p><h4>Radiographic features</h4><p>The long head biceps tendon can be nicely evaluated on soft tissue imaging modalities as ultrasound and MRI <sup>3</sup>.</p><h5>Ultrasound</h5><p>Ultrasound can readily identify the long head biceps tendon in the bicipital groove beneath the transverse humeral ligament usually with a minimal amount of surrounding fluid. From there it can be traced upwards through the rotator interval to its origin at the superior glenoid. It should not be thickened and show any tears or fibre discontinuities – beware of anisotropy <sup>10</sup>. </p><h5>MRI</h5><p>The long head biceps tendon can be readily seen on MRI of the shoulder as hypointense string like structure encircling the humeral head. It can be affected by the magic angle phenomenon especially in the curve as it encircles the humeral head and enters the bicipital groove.</p><p>Moreover, MRI is able to depict most biceps tendon pathologies except for isolated pulley lesions <sup>3</sup>.</p><h6>MR athrography</h6><p>MR athrography can be used in the detection of biceps pulley injuries and has been shown to have a high accuracy <sup>11</sup>.</p><h4>Related pathology</h4><p>The following pathologies can be associated with the long head biceps tendon <sup>1-3</sup>:</p><p>biceps tendon degeneration</p><p>long head biceps tendon injury</p><p>SLAP lesions</p><p>biceps pulley injury</p><p>biceps tendon dislocation</p><p> </p>- +<p>The<strong> long head of the biceps tendon (LHBT) </strong>is the proximal <a href="/articles/tendon">tendon</a> of the long head of the <a href="/articles/biceps-brachii-muscle-1">biceps muscle</a> and<strong> </strong>encircles the humeral head on its course. It has an intraarticular extrasynovial and extraarticular portion.</p><h4>Summary</h4><ul>
- +<li>
- +<strong>location:</strong> shoulder</li>
- +<li>
- +<strong>insertion: </strong>supraglenoid tubercle of the scapula and superior labrum</li>
- +<li>
- +<strong>blood supply: </strong>anterior humeral circumflex artery, brachial and thoracoacromial arteries</li>
- +<li>
- +<strong>innervation: </strong>sympathetic fibres</li>
- +<li>
- +<strong>relations: </strong>superior labrum, rotator interval, biceps pulley, pectoralis major insertion</li>
- +<li>
- +<strong>function: </strong>stabilizer of the glenohumeral joint</li>
- +</ul><h4>Gross anatomy</h4><p>The long head of the biceps tendon has<strong> </strong>an intraarticular and extrasynovial portion encircling the anterior aspect of the humeral head covered by <a href="/articles/synovium">synovium</a> from the joint capsule that extends into the <a href="/articles/bicipital-groove">bicipital groove</a>. The tendon originates from the superior aspect of the <a href="/articles/glenoid">glenoid</a> and superior labrum, courses through the <a href="/articles/rotator-cuff-interval">rotator interval</a> beneath the coracohumeral ligament and through the bicipital groove <sup>1-3</sup>.</p><h5>Function</h5><p>Functions of the long head biceps tendon include the following <sup>2-4</sup>:</p><ul>
- +<li>force transmission created by the biceps muscle</li>
- +<li>stabilisation of <a href="/articles/glenohumeral-joint">glenohumeral joint</a> especially in the abduction and external rotation</li>
- +</ul><h5>Attachments</h5><p>The tendon originates from the superior supraglenoid tubercle and superior labrum mostly with predominant contributions from the posterior labrum or equal contributions from anterior and posterior labrum <sup>5</sup>.</p><p>Its myotendinous junction is at the proximal humerus at the level of the insertion of the <a href="/articles/pectoralis-major-muscle-1">pectoralis major muscle</a> <sup>2</sup>.</p><h5>Relations and boundaries</h5><p>Above the humeral head and the long head biceps tendon courses through the rotator interval and is bordered by the structures of the <a href="/articles/biceps-pulley">biceps pulley</a> <sup>3</sup>:</p><ul>
- +<li>
- +<a href="/articles/coracohumeral-ligament">coracohumeral ligament</a> superiorly</li>
- +<li>
- +<a href="/articles/glenohumeral-ligaments">superior glenohumeral ligament</a> anteriorly and inferiorly</li>
- +<li>
- +<a href="/articles/supraspinatus-muscle-1">supraspinatus tendon</a> posterosuperiorly</li>
- +<li>
- +<a href="/articles/subscapularis-muscle-2">subscapularis tendon</a> anteroinferiorly</li>
- +</ul><p>Within the bicipital groove, the long head biceps tendon is bordered by the lesser tubercle anteriorly, the greater tubercle posteriorly and covered by the <a href="/articles/transverse-humeral-ligament">transverse humeral ligament</a> <sup>1</sup>.</p><p>The distal part and its myotendinous junction are covered by insertion of the pectoralis major muscle.</p><h4>Arterial supply</h4><p>The proximal part of the long head biceps including parts of the bicipital groove appears to be mainly supplied from branches of the <a href="/articles/anterior-humeral-circumflex-artery">anterior humeral circumflex artery</a> <sup>6</sup>. The further distal portions receive their supply from the <a href="/articles/brachial-artery">brachial</a> and <a href="/articles/thoracoacromial-artery">thoracoacromial arteries</a> <sup>4,7</sup>.</p><h4>Innervation</h4><p>The long head biceps tendon is innervated by sensory sympathetic fibres more so in its proximal portion <sup>3</sup>.</p><h4>Variant anatomy</h4><p>Anatomical variants include the following <sup>3,8,9</sup>:</p><ul>
- +<li>congenital absence of the long head biceps tendon</li>
- +<li>double or triple tendon with common or separate origin</li>
- +<li>adherence to the supraspinatus or joint capsule</li>
- +<li>variations in the mesotenon</li>
- +</ul><h4>Radiographic features</h4><p>The long head biceps tendon can be nicely evaluated on soft-tissue imaging modalities as ultrasound and MRI <sup>3</sup>.</p><h5>Ultrasound</h5><p>Ultrasound can readily identify the long head biceps tendon in the bicipital groove beneath the transverse humeral ligament usually with a minimal amount of surrounding fluid. From there it can be traced upwards through the rotator interval to its origin at the superior glenoid. It should not be thickened and show any tears or fibre discontinuities – beware of <a href="/articles/anisotropy">anisotropy</a> <sup>10</sup>. </p><h5>MRI</h5><p>The long head biceps tendon can be readily seen on <a href="/articles/mri-of-the-shoulder-an-approach">MRI of the shoulder</a> as a hypointense string-like structure encircling the humeral head. It can be affected by the <a href="/articles/magic-angle-effect-mri-artifact-1">magic angle effect</a> especially in the curve as it encircles the humeral head and enters the bicipital groove.</p><p>Moreover, MRI can depict most biceps tendon pathologies except for isolated pulley lesions <sup>3</sup>.</p><h6>MR arthrography</h6><p><a href="/articles/glenohumeral-arthrography">MR arthrography</a> can be used in the detection of biceps pulley injuries and has been shown to have a high accuracy <sup>11</sup>.</p><h4>Related pathology</h4><p>The following pathologies can be associated with the long head biceps tendon <sup>1-3</sup>:</p><ul>
- +<li>biceps tendon degeneration</li>
- +<li><a href="/articles/proximal-biceps-tendon-rupture">long head biceps tendon injury</a></li>
- +<li><a href="/articles/superior-labral-anterior-posterior-tear">SLAP lesions</a></li>
- +<li><a href="/articles/biceps-pulley-injury">biceps pulley injury</a></li>
- +<li><a href="/articles/long-head-of-biceps-tendon-dislocation">biceps tendon dislocation</a></li>
- +</ul>
References changed:
- 1. Elser F, Braun S, Dewing C, Giphart J, Millett P. Anatomy, Function, Injuries, and Treatment of the Long Head of the Biceps Brachii Tendon. Arthroscopy. 2011;27(4):581-92. <a href="https://doi.org/10.1016/j.arthro.2010.10.014">doi:10.1016/j.arthro.2010.10.014</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/21444012">Pubmed</a>
- 2. Eakin C, Faber K, Hawkins R, Hovis W. Biceps Tendon Disorders in Athletes. J Am Acad Orthop Surg. 1999;7(5):300-10. <a href="https://doi.org/10.5435/00124635-199909000-00003">doi:10.5435/00124635-199909000-00003</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10504357">Pubmed</a>
- 3. Zappia M, Chianca V, Di Pietto F et al. Imaging of Long Head Biceps Tendon. A Multimodality Pictorial Essay. Acta Biomed. 2019;90(5-S):84-94. <a href="https://doi.org/10.23750/abm.v90i5-S.8351">doi:10.23750/abm.v90i5-S.8351</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/31085977">Pubmed</a>
- 4. Sarmento M. Long Head of Biceps: From Anatomy to Treatment. Acta Reumatol Port. 2015;40(1):26-33. - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25351662">Pubmed</a>
- 5. Vangsness C, Jorgenson S, Watson T, Johnson D. The Origin of the Long Head of the Biceps from the Scapula and Glenoid Labrum. An Anatomical Study of 100 Shoulders. J Bone Joint Surg Br. 1994;76(6):951-4. - <a href="https://www.ncbi.nlm.nih.gov/pubmed/7983126">Pubmed</a>
- 6. Hufeland M, Hamed G, Kubo H et al. Blood Supply in the Bicipital Groove: A Histological Analysis. Orthop Rev (Pavia). 2019;11(1):8106. <a href="https://doi.org/10.4081/or.2019.8106">doi:10.4081/or.2019.8106</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30996843">Pubmed</a>
- 7. Cheng N, Pan W, Vally F, Le Roux C, Richardson M. The Arterial Supply of the Long Head of Biceps Tendon: Anatomical Study with Implications for Tendon Rupture. Clin Anat. 2010;23(6):683-92. <a href="https://doi.org/10.1002/ca.20992">doi:10.1002/ca.20992</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/20821403">Pubmed</a>
- 8. Jeong J, Park S, Park Y, Yoo J. Morphological Classification of Anatomical Variants of the Intra-Articular Portion of the Long Head of the Biceps Brachii Tendon and Analysis of the Incidence and the Relationship with Shoulder Disease for Each Subtype. J Orthop Surg (Hong Kong). 2017;25(3):2309499017742207. <a href="https://doi.org/10.1177/2309499017742207">doi:10.1177/2309499017742207</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29157108">Pubmed</a>
- 9. Battaglia P, Welk A, Kettner N. Ultrasound Appearance and Dynamic Evaluation of Variant Long Head of the Biceps Tendon Anatomy with MRI Correlation. J Ultrasound. 2015;18(2):187-9. <a href="https://doi.org/10.1007/s40477-014-0125-2">doi:10.1007/s40477-014-0125-2</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26191107">Pubmed</a>
- 10. Jacobson J. Shoulder US: Anatomy, Technique, and Scanning Pitfalls. Radiology. 2011;260(1):6-16. <a href="https://doi.org/10.1148/radiol.11101082">doi:10.1148/radiol.11101082</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/21697306">Pubmed</a>
- 11. Schaeffeler C, Waldt S, Holzapfel K et al. Lesions of the Biceps Pulley: Diagnostic Accuracy of MR Arthrography of the Shoulder and Evaluation of Previously Described and New Diagnostic Signs. Radiology. 2012;264(2):504-13. <a href="https://doi.org/10.1148/radiol.12112007">doi:10.1148/radiol.12112007</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22692037">Pubmed</a>
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