The Rotator Interval and Long Head Biceps Tendon: Anatomy, Function, Pathology, and Magnetic Resonance Imaging

Background: The biceps tendon is a known source of shoulder pain. Few high-level studies have attempted to determine whether biceps tenotomy or tenodesis is the optimal approach in the treatment of biceps pathology. Most available literature is of lesser scientific quality and shows varying results in the comparison of tenotomy and tenodesis. Purpose: To compare patient-reported and objective clinical results between tenotomy and tenodesis for the treatment of lesions of the long head of the biceps brachii. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients aged ≥18 years undergoing arthroscopic surgery with intraoperative confirmation of a lesion of the long head of the biceps tendon were randomized. The primary outcome measure was the American Shoulder and Elbow Surgeons (ASES) score, while secondary outcomes included the Western Ontario Rotator Cuff Index (WORC) score, elbow and shoulder strength, operative time, complications, and the incidence of revision surgery with each procedure. Magnetic resonance imaging was performed at postoperative 1 year to evaluate the integrity of the procedure in the tenodesis group. Results: A total of 114 participants with a mean age of 57.7 years (range, 34 years to 86 years) were randomized to undergo either biceps tenodesis or tenotomy. ASES and WORC scores improved significantly from pre- to postoperative time points, with a mean difference of 32.3% ( P < .001) and 37.3% ( P < .001), respectively, with no difference between groups in either outcome from presurgery to postoperative 24 months. The relative risk of cosmetic deformity in the tenotomy group relative to the tenodesis group at 24 months was 3.5 (95% CI, 1.26-9.70; P = .016), with 4 (10%) occurrences in the tenodesis group and 15 (33%) in the tenotomy group. Pain improved from 3 to 24 months postoperatively ( P < .001) with no difference between groups. Cramping was not different between groups, nor was any improvement in cramping seen over time. There were no differences between groups in elbow flexion strength or supination strength. Follow-up magnetic resonance imaging at postoperative 12 months showed that the tenodesis was intact for all patients. Conclusion: Tenotomy and tenodesis as treatment for lesions of the long head of biceps tendon both result in good subjective outcomes but there is a higher rate of Popeye deformity in the tenotomy group. Registration: NCT01747902 ( ClinicalTrials.gov identifier)

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Magnetic resonance imaging without contrast as a diagnostic method for partial injury of the long head of the biceps tendon

Revista Brasileira de Ortopedia (English Edition) ◽

10.1016/j.rboe.2016.12.003 ◽

2017 ◽

Vol 52 (1) ◽

pp. 40-45

Author(s):

Alexandre Tadeu do Nascimento ◽

Gustavo Kogake Claudio

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Diagnostic Method ◽

Biceps Tendon ◽

Resonance Imaging ◽

Long Head

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Magnetic Resonance Imaging of the Long Head of the Biceps Tendon

Journal of Computer Assisted Tomography ◽

10.1097/01.rct.0000284396.29439.4d ◽

2007 ◽

Vol 31 (4) ◽

pp. 642-648 ◽

Cited By ~ 1

Author(s):

Anderson Lin ◽

Julius Ting ◽

Kwo-Whei Lee

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Biceps Tendon ◽

Resonance Imaging ◽

Long Head

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Distance between the supraspinatus and long head of the biceps tendon on sagittal MRI: a new tool to identify anterior supraspinatus insertion injury

Journal of Experimental Orthopaedics ◽

10.1186/s40634-021-00410-6 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Lifeng Yin ◽

Hua Zhang ◽

Yangang Kong ◽

Xinyu Zhang ◽

Wenlong Yan ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Biceps Tendon ◽

Receiver Operating Curve ◽

Magnetic Resonance Imaging Scan ◽

Resonance Imaging ◽

Level Of Evidence ◽

Intact Group ◽

Long Head ◽

Resonance Imaging Scan

Abstract Purpose Anterior insertion of the supraspinatus muscle plays an essential role in rotator cuff tissue. We aimed to determine whether the distance between the midpoints of the supraspinatus central tendon and long head of the biceps tendon on a sagittal shoulder magnetic resonance imaging scan can help to preoperatively diagnose an injury of the anterior insertion of the supraspinatus. Method This retrospective study reviewed 103 patients with a full-thickness supraspinatus tendon tear: 50 patients with (injured group) and 53 patients without (intact group) anterior supraspinatus insertion tear. The inter-tendon distance was measured based on an oblique sagittal magnetic resonance imaging scan. SPSS was used for statistical analyses. Two independent samples t-test and receiver operating curve analysis were also performed. Results The measurements of inter-tendon distance revealed good intra- and inter-observer reliabilities with intra-class correlation coefficients of 0.92 and 0.97, respectively. The inter-tendon distance of the injured group was significantly greater than that of the intact group (10.1 ± 2.7 vs 8.0 ± 2.3 mm, P < 0.001). The diagnostic ability of the inter-tendon distance was fair (area under the curve = 0.745), and a threshold of 9 mm had a specificity of 73% and sensitivity of 74%. Conclusion The distance between the supraspinatus central tendon and long head of the biceps tendon on magnetic resonance imaging was greater in patients with anterior supraspinatus insertion injury than those without the injury. A distance of 9 mm may be the cut-off value and a good diagnosis marker for anterior supraspinatus insertion injury. Level of evidence Level III, diagnostic case–control study.

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Characterization of the Proximal Long Head of Biceps Tendon Anatomy Using Magnetic Resonance Imaging: Implications for Biceps Tenodesis

The American Journal of Sports Medicine ◽

10.1177/0363546520976630 ◽

2020 ◽

pp. 036354652097663

Author(s):

Eugene T. Ek ◽

Andrew J. Philpott ◽

Jennifer N. Flynn ◽

Nada Richards ◽

Andrew J. Hardidge ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Biceps Tendon ◽

Proton Density ◽

Biceps Tenodesis ◽

Resonance Imaging ◽

Wide Variability ◽

Shoulder Mri ◽

Long Head ◽

Superior Border

Background: Biceps tenodesis is a common treatment for proximal long head of biceps (LHB) tendon pathology. To maintain biceps strength and contour and minimize cramping, restoration of muscle-length tension and appropriate positioning of the tenodesis is key. Little is known about the biceps musculotendinous junction (MTJ) anatomy, especially in relation to the overlying pectoralis major tendon (PMT), which is a commonly used landmark for tenodesis positioning. Purpose: To characterize the in vivo topographic anatomy of the LHB tendon, in particular the MTJ relative to the PMT, using a novel axial proton-density magnetic resonance imaging (MRI) sequence. Study Design: Descriptive laboratory study. Methods: In total, 45 patients having a shoulder MRI for symptoms unrelated to their biceps tendon or rotator cuff were prospectively recruited. There were 33 men and 12 women, with a mean age of 37 ± 13 years (range, 18-59 years). All patients underwent routine shoulder MRI scans with an additional axial proton density sequence examining the LHB tendon and its MTJ. Three independent observers reviewed each MRI scan, and measurements were obtained for (1) MTJ length, (2) the distance between the proximal MTJ and the superior border of the PMT (MTJ-S), (3) the distance between the distal MTJ to the inferior border of the PMT, and (4) the width of the PMT. Results: The average position of the MTJ-S was 5.9 ± 10.8 mm distal to the superior border of the PMT. The mean MTJ length was 32.5 ± 8.3 mm and the width of the PMT was 28.0 ± 7.3 mm. We found no significant correlation between patient age, height, sex, or body mass index and any of the biceps measurements. We observed wide variability of the MTJ-S position and identified 3 distinct types of biceps MTJ: type 1, MTJ-S above the PMT; type 2, MTJ-S between 0 and 10 mm below the superior border of the PMT; and type 3, MTJ-S >10 mm distal to the superior PMT. Conclusion: In this study, the in vivo anatomy of the LHB tendon is characterized relative to the PMT using a novel MRI sequence. The results demonstrate wide variability in the position of the MTJ relative to the PMT, which can be classified into 3 distinct subtypes or zones relative to the superior border of the PMT. Understanding this potentially allows for accurate and anatomic placement of the biceps tendon for tenodesis. Clinical Relevance: To our knowledge, this is the first study to radiologically analyze the in vivo topographic anatomy of the LHB tendon and its MTJ. The results of this study provide more detailed understanding of the variability of the biceps MTJ, thus allowing for more accurate placement of the biceps tendon during tenodesis.

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