Long Head Biceps Subluxation

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Long Head Biceps Subluxation

Authors, Editors, Case Information Author: Jonathan Mason, DO Affiliation: Wake Forest University Co Author(s): Christopher Miles, MD FAMSSM Senior Editor: Laura Mattson, DO Clinical Vignette: A tennis player with worsening right shoulder pain for 3 months, presented for concern of biceps tendonitis. Speed's test and Yergason's test were positive. Type of Probe Used: L15 5-15 MHZ linear array transducer Image 3 LAX labeled Long axis view of the bicipital groove between the greater tuberosity and lesser tuberosity of the humerus. Note that the groove still has a hyperechoic appearance. This can deceive the scanner to believe that the long head of the biceps is still within the groove. #2 - Video View Video Short axis view beginning at the intersection of the long head of the biceps tendon with the pectoralis major, and then gliding proximally in the short axis towards the rotator interval. #3 - Video View Video Short axis view beginning at the intersection of the long head of the biceps tendon with the pectoralis major, and then gliding proximally in the short axis towards the rotator interval. Note the occasional transducer tilt to account for anisotropy of the long head of the biceps as the scan glides proximally. Image 3 LAX unlabeled Long axis view of the bicipital groove between the greater tuberosity and lesser tuberosity of the humerus. Image 4 SAX unlabeled Short axis view of the long head of the biceps that is subluxed medially and is positioned superficial to the subscapularis and deep to the deltoid. The coracoid process is on the left side of the picture (medial) and is at the level of the coracohumeral ligament. Image 1 SAX labeled Short axis view of the long head of the biceps that is subluxed medially superficial to the subscapularis. Image 2 SAX unlabeled Short axis view of the long head of the biceps with the coracoid process visualized. Image 1 SAX unlabeled Short axis view of the long head of the biceps at the level of the biceps groove and subscapularis. Interpretation Image Interpretation: The long head of the biceps tendon is demonstrative for medial subuxation 2+cm out of the bicipital groove, and is lodged between the subscapularis and deltoid muscle. A video clip of the right shoulder - oriented in short axis - that begins at the pectoralis tendon and glides along the short axis proximally towards the rotator interval highlights the long head subluxation. Teaching Pearl: Subluxations of the long head of the biceps usually occur in the medial direction, and there is often a concomitant subscapularis tendon tear. An empty bicipital groove can sometimes be hyperechoic and this may initially give the appearance of a normal "filled" groove. Scanning from the level of the pectoralis major in the short axis and then gliding proximally towards the rotator interval will allow the scanner to accurately follow the long head of the biceps as it subluxes out of the groove. The subscapularis should be scrutinized for any injury.
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Authors, Editors, Case Information

Image 3 LAX labeled

#2 - Video

#3 - Video

Image 3 LAX unlabeled

Image 4 SAX unlabeled

Image 1 SAX labeled

Image 2 SAX unlabeled

Image 1 SAX unlabeled

Interpretation

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