The Biceps Tendon: From Proximal to Distal

David Y. Ding,Garret Garofolo,Dylan Lowe,Eric J. Strauss,Laith M. Jazrawi

The function of the long head of the biceps tendon (LHB) in shoulder glenohumeral biomechanics is unclear. However, there is agreement that the biceps can develop tendinopathy resulting in pain over the anterior aspect of the shoulder, specifically in the bicipital groove. With recent advancements in arthroscopy and more detailed imaging, selection of appropriate management for proximal biceps disorders is important.

Compared with this proximal component, the anatomy, epidemiology, and underlying pathophysiology of the distal component of the biceps tendon are less well understood. Although distal biceps rupture has a low annual incidence, approximately 1.2 per 100,000 persons, it can lead to substantial morbidity. The emerging understanding of the clinical importance of distal biceps ruptures and the effectiveness of distal biceps repair are the focal points for the increased attention to this topic.

Patients are unique individuals who may be best suited for a specific treatment depending on their age, activity level, and goals. The ideal repair would be one that is anatomic, permits early motion, and has low surgical morbidity and minimal complications. Our review provides an overview of the anatomic, biomechanical, and clinical literature that fully encompasses the biceps brachii from origin to insertion with an emphasis on treatment indications, surgical approaches, fixation techniques, and clinical outcomes.

THE PROXIMAL ASPECT OF THE BICEPS TENDON

Anatomy

The LHB arises from the superior glenoid labrum and supraglenoid tubercle. This proximal, intra-articular portion of the biceps tendon has an asymmetric network of sensory sympathetic nerve fibers, predominantly near its origin, and is a primary pain generator in the anterior aspect of the shoulder4. The reflection pulley—composed of fibers from the superior glenohumeral ligament, coracohumeral ligament, and superior aspect of the subscapularis tendon—functions to stabilize the biceps tendon as it advances through the bicipital groove(Fig. 1). As the LHB enters …