Abnormal origins of the long head of the biceps tendon can lead to rotator cuff pathology: a report of two cases

Zhang, Alan L.; Gates, Cameron H.; Link, Thomas M.; Benjamin, C.

doi:10.1007/s00256-014-1910-x

Cited by 5 publications

(3 citation statements)

References 17 publications

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“…Proposing this as one of the possible etiologies of the rotator cuff tear, they showed that when the long head of the biceps brachii was attached to the supraspinatus anterior aspect, good clinical outcome was achieved. Another study that supports the surgical treatment of variations of the long had is that of Zhang et al 8) They reported of two cases of variations of the long head that originated from the anterior aspect of the supraspinatus tendon, and suggested this as an etiological deformity that induced the tear of the supraspinatus through the input of excessive tension. In accordance to their hypothesis, tenodesis of the biceps tendon of these two patients, which reduces the excess tension on the tendons, gave good clinical outcomes.…”

Section: Discussionmentioning

confidence: 87%

“…Overall, these studies give a mixed message for the treatment of anatomic variations of the biceps brachii long head. However, when we consider that the rotator cuff tears of the cases described by Ogawa and Naniwa 7) and Zhang et al 8) cannot solely be explained by anatomic variations of the long head, it is difficult to implicate anatomic variations as being the direct causative factor and erroneously conclude a benefit of surgical interventions. This is because Ogawa and Naniwa 7) sought to prove a clinical significance of disconnecting a long head using an already disconnected one, and Zhang et al 8) studied subjects, currently active young volleyball and baseball athletes, wherein it is difficult to preclude sports-related injuries as etiology for the rotator cuff tear.…”

Section: Discussionmentioning

confidence: 93%

“…However, when we consider that the rotator cuff tears of the cases described by Ogawa and Naniwa 7) and Zhang et al 8) cannot solely be explained by anatomic variations of the long head, it is difficult to implicate anatomic variations as being the direct causative factor and erroneously conclude a benefit of surgical interventions. This is because Ogawa and Naniwa 7) sought to prove a clinical significance of disconnecting a long head using an already disconnected one, and Zhang et al 8) studied subjects, currently active young volleyball and baseball athletes, wherein it is difficult to preclude sports-related injuries as etiology for the rotator cuff tear. As surgical intervention has not yet been proven as a significantly better treatment method over conservative management, we believe that when there is no clear arthroscopic indication of lesions of the long head in a physical examination or of mechanical stress, for example on supraspinatus tears, the merit of surgical treatment for long head of biceps tendons that are attached to the rotator cuff or run to inner supraspinatus tendon remains questionable.…”

Section: Discussionmentioning

confidence: 93%

See 2 more Smart Citations

Three Cases of Rare Anatomic Variations of the Long Head of Biceps Brachii

Kwak

Lee

Song³

et al. 2015

Clinics in Shoulder and Elbow

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In general, the long head of the biceps brachii originates from the superior glenoid labrum and the supraglenoid tubercle, crosses the rotator cuff interval, and extends into the bicipital groove. However, rare anatomic variations of the origins of the long head have been reported in the past. In this report, we review the clinical history, radiologic findings, and arthroscopic identifications of 3 anatomic variants of the biceps tendon long head. As the detection of long head of biceps tendon pathology during preoperative radiologic assessment can be difficult without prior knowledge, surgeons should be aware of such possible anatomic variations. In general, the long head of the biceps brachii originates from the superior glenoid labrum and the supraglenoid tubercle. From its origin, the long head traverses along the rotator interval and the humeral head and extends into the bicipital groove. 1)Cadaver studies by Vangsness et al.2) have shown that around 50% of long heads of the biceps brachii originate from the superior labrum while the rest arises from the supraglenoid tubercle. It is reported that most tendinous fibers of the long head of the biceps brachii merge with the labrum at the posterior superior labrum. Anatomic variations in the origins of the long head of the biceps brachii are rare. Dierickx et al.3) have shown only 1.91%of patients undergoing arthroscopic surgery show such anomaly. Broadly, anatomic variations is classified into whether they have anomalous origins or there is a congenital absence of the long head itself. 3,4) Most of these variations are only revealed coincidently during arthroscopic surgery, and the clinical significance of these anatomic variants remain unclear. Although there have been reports that congenital absence of the long head of biceps brachii contributes to the instability of the shoulder or to related congenital defects, 5) there is no conclusive evidence as of yet to implicate these anatomic variations to shoulder pathology.Until now, only a single case of an anatomic variation of the origin of the long head other than congenital absence has been reported in the Korean literature.6) In this report, we describe 3 cases of anatomic variations of the long head of the biceps brachii found during arthroscopic repairs of supraspinatus tendon tears. Case Report Case 1A 40-year-old female was hospitalized with chronic pain on the right shoulder that began 3 weeks prior to the observation. The patient had no job sequence and no exercise routines other than static yoga poses that she performed. The patient showed no obvious signs of trauma, but experienced severe pain with forward elevation of the arm and night pain. She had a visual analogue scale (VAS) for pain of 5. During physical examination, the patient presented with limited passive range of motion (ROM) of the shoulders; 150 o of forward elevation and 150 o of abduction of the arm. Further, the patient showed signs of impingement, a positive outcome for the empty can test, and tenderness at the supraspinatus attachme...

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Section: Discussionmentioning

confidence: 87%