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

Kumar, C. Devendra; Rakesh, J.; Bansal, Tungish; Singh, Dharminder

doi:10.32098/mltj.03.2017.21

Cited by 7 publications

(5 citation statements)

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“…A positive correlation was found between observed anatomical variances of the LHBT origin and the presence of anterosuperior labral fraying, abnormal superior glenohumeral ligament [7], and LHBT absence and the presence of shoulder pain and instability [10].…”

Section: Anatomical Variationsmentioning

confidence: 75%

“…However, there are certain disadvantages to the treatment, such as the potential deformity of the arm's anatomic profile (Popeye sign), the possibility of cramping and fatigue pain, and biomechanical modifications to the humeral head's response to LHBT capacity [10]. Tenotomy and tenodesis have different rates of esthetic deformity (Popeye sign) at 43 and 8%, respectively [21].…”

Section: Arthroscopic Tenotomy Versus Open Tenodesis Of the Long Head...mentioning

confidence: 99%

“…Due to the drawbacks of tenotomy, some surgeons support tenodesis, which, despite longer recovery periods and a more technically challenging procedure, results in a better ability to return to activity, a lower incidence of cosmetic deformities and cramping pain, and a closer approximation of normal anatomy [10].…”

Section: Arthroscopic Tenotomy Versus Open Tenodesis Of the Long Head...mentioning

confidence: 99%

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Arthroscopic Tenotomy Versus Open Tenodesis of the Long Head Biceps Brachii Tendon

Delvecchio,

Mario Micheloni,

Giorgini

et al. 2023

Shoulder Surgery - Open vs Arthroscopic Techniques

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The aim of the chapter is to compare the surgical treatment of tendinopathies of the long head of the biceps brachii, in particular arthroscopic tenotomy versus open tenodesis. Arthroscopic tenotomy of the long head of the biceps tendon is the preferred technique in cases where pain is to be relieved and in cases where the long head is subluxated with injury to the upper fibers of the subscapularis muscle. Subpectoral open tenodesis of the long head of the biceps tendon may be the preferable technique in selected cases of younger patients, athletes, or with high functional demand; in these cases, a good recovery of muscle strength, less muscle cramping, and less imperfection should be achieved.

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Section: Anatomical Variationsmentioning

confidence: 75%

Section: Arthroscopic Tenotomy Versus Open Tenodesis Of the Long Head...mentioning

confidence: 99%

Section: Arthroscopic Tenotomy Versus Open Tenodesis Of the Long Head...mentioning

confidence: 99%

See 1 more Smart Citation

Arthroscopic Tenotomy Versus Open Tenodesis of the Long Head Biceps Brachii Tendon

Delvecchio,

Mario Micheloni,

Giorgini

et al. 2023

Shoulder Surgery - Open vs Arthroscopic Techniques

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“…Additionally, a systematic review reported that the absence of the LHBT is frequently linked with shoulder pain (85.7%) and instability (37.1%). However, the authors remained inconclusive about whether the absence of the LHBT should be perceived as a predisposing factor for rotator cuff or labral pathology or if it remains incidental and lacks clinical relevance ( 12 ).…”

Section: Lhbt’s Role In Shouldermentioning

confidence: 99%

Biceps tendon autograft augmentation for rotator cuff and instability procedures: a narrative review

Laprus,

Juszczak,

Brzóska

et al. 2024

EFORT Open Reviews

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Rotator cuff tears (RCT) and instability are the most common surgically treated shoulder pathologies. The concept of augmentation using the long head of the biceps tendon (LHBT) autograft was created to improve the results of surgical treatment of these pathologies, especially in cases of chronic and massive injuries. The popularity of using the LHBT for augmentation is evidenced by the significant number of publications on this topic published in the last 3 years; however, only one systematic review has been published regarding only LHBT augmentation for massive RCTs. Several studies comparing partial repair with partial repair and additional LHBT augmentation for RCT showed superior clinical outcomes and lower re-tear rates when LHBT augmentation was performed. There is a rising popularity of using LHBT as an autograft to perform superior capsule reconstruction (SCR) in case of irreparable rotator cuff tears. In recent years, shoulder stabilization by arthroscopic Bankart repair with biceps augmentation has been promoted with very promising short-term results. The evidence provided by studies appears to be sufficient to recommend the use of LHBT for augmentation whenever necessary; however, larger studies with long-term follow-up are needed.

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“…A solitary case study observed a Partial Articular-sided Supraspinatus Tendon Avulsion (PASTA) in two patients with an anomalous origin of the LHBT from the Supraspinatus. Two large case series studies and a single systematic review reported a positive correlation between (a) observed anatomical variances of the LHBT origin and the presence of anterosuperior labral fraying (odds ratio, 3.58; p = 0.000), abnormal superior glenohumeral ligament (odds ratio, 3.69; p = 0.012) [ 57 ], and (b) LHBT absence and the presence of shoulder pain (85.7%) and instability (37.1%) [ 167 ]. Whilst shoulder joint instability was more prevalent in biceps variations in the mesotenon; it did not reach significance (27.6%: 14.9%, p = 0.305) [ 163 ].…”

Section: Anatomymentioning

confidence: 99%

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 the long head of biceps tendon and its clinical implications: a systematic review of the literature

Cited by 7 publications

References 0 publications

Arthroscopic Tenotomy Versus Open Tenodesis of the Long Head Biceps Brachii Tendon

Arthroscopic Tenotomy Versus Open Tenodesis of the Long Head Biceps Brachii Tendon

Biceps tendon autograft augmentation for rotator cuff and instability procedures: a narrative review

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

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