Congenital absence of long head of the biceps tendon

Gillardin, Patrick; Vanhoenacker, Filip; Wauters, T; Backer, AI De

doi:10.5334/jbr-btr.446

Cited by 3 publications

(2 citation statements)

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“…Anomalies of the long head of the bicep brachii include absence, hypoplasia, duplication and various origins (from the capsular ligaments, the bicipital groove, the insertion of the oracobrachialis, the tendon of the pectoralis major and the greater tuberosity of the humerus) 2 . Absence of the tendon of the long head of the biceps brachii can be congenital and is associated with other anomalies such as the VATER association, which includes vertebral defects, anal atresia, tracheo-esophageal fistula with esophageal atresia, radial anomalies and renal anomalies 3 . Variations, with the exception of congenitally absent long heads are classified in terms of their relationship, or extent of fusion, with the supraspinatus tendon 4 .…”

Section: Discussionmentioning

confidence: 99%

“…This underlines the need for surgical awareness during arthroscopic surgery due to possible unexpected anatomical variations or lesions of the LHB 4 . Diagnostic difficulties at the time of shoulder arthroscopy also arise from the fact that the tendon of the long head of biceps brachii is used as a landmark and may confuse even experienced surgeons 3,9 .…”

Section: Wahl and Mcgillivray Classified The Anatomical Variants Of Tmentioning

confidence: 99%

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A Rare Anomaly of the Long Head of the Biceps Brachii Muscle

Kumar

Baidya

Baral³

2018

J. Gandaki Med. Coll. Nepal

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Introduction: Biceps brachii is a muscle of arm which brings about supination when fore-arm is flexed and flexion of elbow joint. Proximally it is attached with two heads: long and short heads.Case report: The absence of long head of biceps brachii muscle is very rare anomaly. It may be unilateral or bilateral with or without other congenital anomalies. The exact prevalence of this anomaly is unknown. This anomaly has been reported to occur as the result of an insult to the fetus during the sixth or seventh week of gestation, at which time the long head of the biceps tendon is developing. J-GMC-N | Volume 11 | Issue 01 | January-June 2018, Page:56-57

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Section: Discussionmentioning

confidence: 99%

Section: Wahl and Mcgillivray Classified The Anatomical Variants Of Tmentioning

confidence: 99%

A Rare Anomaly of the Long Head of the Biceps Brachii Muscle

Kumar

Baidya

Baral³

2018

J. Gandaki Med. Coll. Nepal

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Congenital absence of the long head of biceps tendon & its clinical implications: a systematic review of the literature

Kumar

John

Bansal

et al. 2017

MLTJ

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SummaryBackground: Multiple reports of congenitally absent long head of biceps tendon (LHBT) have been reported in the literature. However, there is no consensus on the clinical implications of this relatively rare entity. Study Purpose: To systematically review and analyze all studies which have reported absence of LHBT. Methods: PubMed and EMBASE databases were searched. Also, a secondary search was performed by pearling the bibliography of all the fulltext articles obtained. Pre defined inclusion criteria was used for abstract screening by two independent observers. Twenty three studies met our inclusion criteria, were included for the final analysis and the data was pooled. The cases were further sub-grouped according to the classification of Dierickx et al. Results: Till date, 35 cases of absent LHBT have been reported. Males and females were equally affected. Eight of these were bilateral and only four cases had other associated congenital anomalies. Majority of the patients presented with shoulder pain (85.7%) while 37.1% had shoulder instability (mainly anterior instability). The ABS type was the most common variant reported. The finding was missed in 60% of the cases on the initial MRI only to be detected later on shoulder arthroscopy. Conclusions: Congenitally absent LHBT may not be as rare as was previously thought to be. Due to the heterogeneity and the low level of evidence of the data available, it is hard to conclude if a congenitally absent LHBT is a cause of shoulder pain/impingement or instability on its own. Level of evidence: IV.

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

Diplock

Hing

Marks

2023

BMC Musculoskelet Disord

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Background This review aimed to explore the available literature to update our understanding of the long head of biceps (LHB) at the shoulder. Synthesise our findings to identify emergent themes and knowledge gaps to inform future research and management directions. Methods PubMed, Embase, Cinahl, SportDiscus, CENTRAL, and Web of Science were searched from inception to 31st December 2021. Articles were included if they referenced adult participants > 18 years of age and were written in English. Results 214 articles were included in the final analysis, and results were categorised into six emergent themes: (1) Anatomy - Normal anatomical variation of the biceps from aberrant origins, third and fourth accessory heads, and an absence of the LHB tendon (LHBT) are not necessarily benign, with shoulder pain and instability a commonly reported theme. (2) Function - Bicep’s role in glenohumeral elevation and stability in healthy shoulders is minimal. In contrast, LHB has a more significant role in shoulder stability and humeral head depression in subjects with rotator cuff failure or an absent LHBT. (3) Pathology - There is an association between LHB tendinopathy, rotator cuff disease, LHBT instability and occult rotator cuff tears. Early recruitment and hyperactivity of the LHB in subjects with symptomatic rotator cuff tears and instability suggest a potential compensatory role. (4) Assessment - The limited diagnostic utility of special orthopaedic tests in assessing LHBT pathology was a consistent theme. The utility of magnetic resonance imaging and ultrasound to identify full-thickness tendon tears and instability of the LHBT was moderate to high. However, the utility of clinical tests and imaging may be underestimated due to arthroscopy’s limitations in fully visualising the proximal LHBT. (5) Non-Surgical Management - Ultrasound-guided injections into the biceps sheath show greater accuracy and patient outcomes than blinded injections; however, the entry of injectate into the intraarticular glenohumeral joint may have unwanted complications. (6) Surgical management - For the surgical management of biceps pathology with or without rotator cuff pathology, both biceps tenodesis and tenotomy report similar improvements in pain without any significant adverse effect on strength or function. Tenodesis favoured higher overall constant scores and a lower incidence of Popeye deformity and cramping arm pain, with tenotomy trending to be more cost and time effective. For patients with a healthy LHBT, rotator cuff repair with adjunctive tenodesis or tenotomy fails to provide additional clinical improvements compared to rotator cuff repair in isolation. Conclusions The scoping review highlights the variability of biceps anatomy, which is not necessarily benign and suggests a minimal role of the LHB in shoulder elevation and stability in healthy individuals. In contrast, individuals with rotator cuff tears experience proximal humeral migration and demonstrate hyperactivity of the LHB, suggesting a potential compensation role. The observed prevalence of LHBT pathology with rotator cuff tears is well established; however, the cause-and-effect relationship between LHBT pathology and rotator cuff disease is undetermined. The diagnostic utility of clinical tests and imaging to exclude LHBT pathology may be understated due to the limitations of arthroscopy to visualise the proximal LHBT fully. Rehabilitation programs for the LHB are understudied. Similar post-surgical clinical outcomes are observed for tenodesis and tenotomy for biceps and rotator cuff-related shoulder pain. Subjects undergoing biceps tenodesis are less likely to have cramping arm pain and a Popeye deformity than patients undergoing biceps tenotomy. The significance of routine surgical removal of the LHBT and sequelae on rotator cuff tear progression to failure and long-term shoulder function is unknown, and further research is required. Pre-registration OSF: https://osf.io/erh9m

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Congenital absence of long head of the biceps tendon

Cited by 3 publications

References 1 publication

A Rare Anomaly of the Long Head of the Biceps Brachii Muscle

A Rare Anomaly of the Long Head of the Biceps Brachii Muscle

Congenital absence of the long head of biceps tendon & its clinical implications: a systematic review of the literature

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

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