Clinical relevance of the anatomy of the long head bicipital groove, an evidence‐based review

Abstract

Pathology in the bicipital groove can be a source of anterior shoulder pain. Many studies have compared treatment techniques for the long head biceps tendon (LHBT) without showing any clinically significant differences. As the LHBT is closely related to the bicipital groove, anatomical aspects of this groove could also be implicated in surgical outcomes. The aim of this review is to contribute to developing the optimal surgical treatment of LHBT pathology based on clinically relevant aspects of the bicipital groove. Medline/PubMed was systematically searched using key words “bicipital” and “groove” and combinations of their synonyms. Studies reporting on evolution, embryonic development, morphometry, vascularization, innervation, and surgical treatment of the LHBT and the bicipital groove were included. The length of the bicipital groove reported in the included studies ranged from 81.00 mm to 87.33 mm, width from 7.74 mm to 11.60 mm, and depth from 3.70 mm to 6.00 mm. The anatomy of the bicipital groove shows a bottleneck narrowing approximately two‐thirds from superior. The transverse humeral ligament can constrain the bicipital groove and could be involved in anterior shoulder pain. When either LHBT tenotomy or tenodesis is performed, routinely releasing the transverse ligament could decrease postoperative anterior shoulder pain, which has frequently been reported in the literature. To avoid the bottle neck narrowing, a location below the bicipital groove may be preferred for biceps tenodesis over a more proximal tenodesis site. Level of evidence: IV.

Tenotomy or Tenodesis for Tendinopathy of the Long Head of the Biceps Brachii: An Updated Systematic Review and Meta-analysis

“…Some authors suggested that the surrounding tissues in the bicipital grove such as the transverse ligament may play a role in persisting pain after either LHB tenotomy or tenodesis. 52 , 53 Persisting pain after either procedure may be explained in cases in which deroofing the bicipital groove has not been performed, 52 which could clarify the similar results with regard to persisting pain in both groups in this meta-analysis. Surprisingly, Anil and colleagues found the lowest rates of persistent groove pain in groups that had undergone arthroscopic suprapectoral tenodesis, 47 and a recent meta-analysis by van Deurzen and colleagues found no clinically relevant differences between suprapectoral and subpectoral tenodesis.…”

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

“…Occult Subscapularis tears typically occur when biceps sling integrity is compromised, displacing the unstable LHBT anteromedially into the Subscapularis tendon, leading to subsequent tearing [ 242 – 244 ]. Other potential mechanisms of LHB tendinopathy include mechanical constriction and irritation from a bottleneck narrowing of the biceps groove [ 245 ].…”

Clinical implications of the distinct anatomy and innervation of the long head biceps tendon

“…When nonoperative approaches fail to provide pain relief, surgical treatment options include debridement, biceps tenotomy, or tenodesis, but the optimal treatment continues to be a topic of debate (Anil et al, 2020; Boileau et al, 2004; Deurzen et al, 2020; Frank et al, 2018; MacDonald et al, 2020; McCrum et al, 2019; Sanders et al, 2012; Taylor et al, 2015; Taylor & O'brien, 2016). In both procedures, the LHBT is cut at its origin, allowed to retract in the tenotomy procedure, or reattached to the humerus in the tenodesis procedure.…”