Long Head of the Biceps – Various Tendon Pathologies

Autor: RAFAŁ CZEPUŁKOWSKI
Consultation MACIEJ PAWLAK
Date added 23.12.2024
Date of last revision 23.12.2024

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Shoulder pain caused by pathology of the long head of the biceps tendon (LHBT) is quite common among athletes participating in throwing sports and those engaging in repetitive overhead activities. These include volleyball players, handball players, tennis players, swimmers, as well as CrossFit enthusiasts and gymnasts. Pathologies of the long head of the biceps tendon can be chronic, resulting from tendon or sheath inflammation, or traumatic, involving complete rupture.

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Anatomy

The biceps brachii muscle, commonly referred to as the biceps, consists of two heads that attach distally to the radial tuberosity. Proximally, the short head tendon, along with the coracobrachialis muscle, attaches to the coracoid process of the scapula, while the long head tendon passes through the bicipital groove, between the greater and lesser tubercles, wraps around the head of the humerus, and attaches to the glenoid. The tendon has unique anatomical and biomechanical properties that make it highly sensitive. Due to its course, the long head of the biceps tendon (LHBT) is subjected to various forces and may develop multiple pathologies. For this reason, the long head of the biceps has long been recognized as a frequent source of shoulder pain.

Pathology of the Long Head of the Biceps Tendon

The biceps is a two-joint muscle, acting on both the elbow and shoulder joints. In both cases, its primary function is flexion, although its role in the shoulder joint is significantly weaker. The function of the long head of the biceps is minor, mainly assisting in abduction and internal rotation of the arm. However, due to its course—wrapping around the humeral head and passing through the bicipital groove—it is prone to various pathologies. At the tendon’s attachment to the glenoid, SLAP lesions (described in another Rehasport article) often occur. At the entry to the groove, degenerative and inflammatory changes frequently develop, leading to damage and even ruptures at this location. Pathologies of the long head of the biceps can be classified as chronic or acute.

Chronic pathologies include various types of inflammation associated with the anatomical position of the tendon, which runs near the subacromial bursa and the supraspinatus tendon. When inflammation affects the bursa or tendon, it often involves the long head of the biceps as well. Another chronic pathology is instability of the long head of the biceps. For various reasons, such as partial tears of the rotator cuff tendons (supraspinatus or subscapularis) or damage to ligaments that stabilize the long head of the biceps in the groove, the tendon may destabilize. This can result in the tendon slipping over the lesser or greater tubercle, initially causing inflammation in the shoulder area and eventually rupture.

Acute pathologies include rupture of the long head of the biceps tendon, which occurs quite frequently. This is primarily associated with degenerative changes in the tendon. A healthy long head tendon rarely ruptures. It is important to note that pathology of the long head of the biceps often accompanies rotator cuff tears and subacromial bursitis, necessitating comprehensive treatment. This pathology is considered one of the most common causes of shoulder problems reported to orthopedic specialists.

Typical Symptoms of Long Head of the Biceps Tendon Pathology

  • Pain
  • Limited range of motion, especially internal rotation—reaching behind, putting on a coat, external rotation with abduction—difficulty fastening a bra in women
  • Snapping sensation
  • Palpable tenderness in the bicipital groove

Diagnosis

The foundation of diagnosis is a properly conducted physical examination, which can save time if surgical treatment is required. The physician may perform several tests, such as the Speed’s test or Yergason’s test.

Speed’s Test is performed with the patient standing, the upper limb relaxed along the torso, and the forearm in supination. The physician applies resistance near the wrist with one hand and stabilizes the shoulder with the other. The patient performs shoulder flexion (elbow extended) to 60 degrees. Pain in the shoulder area during this movement may indicate damage to the long head of the biceps tendon.

Yergason’s Test is also performed with the patient standing, the elbow flexed at 90 degrees, and the forearm in pronation. The physician stabilizes the shoulder with one hand and applies resistance to the forearm with the other. The patient attempts supination of the forearm and external rotation of the shoulder. Pain during resistance suggests damage to the long head of the biceps tendon.

During diagnostics, the physician may complement the physical examination with imaging studies. Early pathology of the long head of the biceps tendon and its intra-articular course can be visualized using magnetic resonance imaging (MRI). However, for instability caused by damage, ultrasound (USG) is more effective because it is a dynamic test that can better demonstrate an unstable tendon. The most accurate method for diagnosing long head of the biceps tendon pathology is arthroscopy.

Treatment

Comprehensive physiotherapy yields good results in treating most long head of the biceps tendon pathologies. Exceptions include structural damage with symptoms of tendon instability or rotator cuff tears. Occasionally, in cases of prolonged inflammation, a steroid injection may be necessary. Ruptures of the long head of the biceps tendon rarely require surgical treatment. Surgery is mainly performed in young athletes or under specific circumstances. Chronic pathologies are treated surgically, where the physician may perform tenotomy (cutting the long head of the biceps tendon) or tenodesis (stabilizing the long head of the biceps tendon and excluding it from the mechanical function of the shoulder). These procedures help alleviate inflammation, effectively relieving the patient’s pain.

Related Articles:
Discover other possible shoulder injuries and conditions.

Bibliography:

Autor
RAFAŁ CZEPUŁKOWSKI
RAFAŁ CZEPUŁKOWSKI

Specjalista do spraw content marketingu, dziennikarz sportowy i medyczny. Redaktor naczelny magazynu „Poradnik Zdrowie i Sport”, członek Dziennikarskiego Klubu Promocji Zdrowia, współtwórca wielu artykułów medycznych z zakresu ortopedii i urazowości w sporcie.

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Konsultacja merytoryczna
MACIEJ PAWLAK
MACIEJ PAWLAK

Lekarz w klinice Rehasport, specjalizuje się w ortopedii i traumatologii narządu ruchu z ukierunkowaniem na staw kolanowy, biodrowy i barkowy. Międzynarodowy trener chirurgii barku i kolana prowadzący praktyczne kursy dla ortopedów zarówno w Polsce, jak i za granicą.

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