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 Unlabeled Short Axis View of the Long Head of Biceps Tendon at the Subscapularis Unlabeled Short Axis View of the Long Head of Biceps Tendon at the level of the biceps groove and subscapularis. Labeled Short Axis View of the Long Head of Biceps Tendon Labeled Short Axis View of the Long Head of Biceps Tendon that is subluxed medially superficial to the subscapularis. Unlabeled Short Axis View of the Long Head of Biceps Tendon at the Coracoid Process Short axis view of the long head of the biceps at the level of the coracoid process. Labeled Short Axis View of the Long Head of Biceps Tendon at the Coracoid Process Labeled Short Axis View of the Long Head of Biceps Tendon at the Coracoid Process that is subluxed medially and is positioned superficial to the subscapularis and deep to the deltoid. Unlabeled Long Axis View of the Bicipital Groove Unlabeled Long Axis View of the Bicipital Groove Labeled Long Axis View of the Bicipital Groove Labeled Long Axis View of the Bicipital Groove. 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. #7 - Video View Video Unlabeled Short axis cine of the biceps long head tendon from distal to proximal. #8 - Video View Video Labeled Short axis cine of the biceps long head tendon from distal to proximal with medial subuxation out of the bicipital groove. Interpretation Image Interpretation: The long head of the biceps tendon is demonstrative of medial subuxation 2+cm out of the bicipital groove, and is lodged between the subscapularis and deltoid muscle. Teaching Pearl: Long head biceps subluxation usually occurs medially and is often associated with subscapularis tendon tearing. Ultrasound should scan the bicipital groove in short axis, follow the tendon to the rotator interval, and use dynamic shoulder rotation to evaluate instability. An empty bicipital groove can appear deceptively echogenic and may be mistaken for a normal tendon-filled groove. Confirm the actual tendon location and assess the subscapularis before concluding the biceps exam is normal. References: 1. Farin PU, Jaroma H, Harju A, Soimakallio S. Medial displacement of the biceps brachii tendon: evaluation with dynamic sonography during maximal external shoulder rotation. Radiology. 1995;195(3):845-848. doi:10.1148/radiology.195.3.7754019 2. Armstrong A, Teefey SA, Wu T, et al. The efficacy of ultrasound in the diagnosis of long head of the biceps tendon pathology. J Shoulder Elbow Surg. 2006;15(1):7-11. doi:10.1016/j.jse.2005.04.008 3. Braun S, Horan MP, Elser F, Millett PJ. Lesions of the biceps pulley. Am J Sports Med. 2011;39(4):790-795. doi:10.1177/0363546510393942
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Authors, Editors, Case Information

Unlabeled Short Axis View of the Long Head of Biceps Tendon at the Subscapularis

Labeled Short Axis View of the Long Head of Biceps Tendon

Unlabeled Short Axis View of the Long Head of Biceps Tendon at the Coracoid Process

Labeled Short Axis View of the Long Head of Biceps Tendon at the Coracoid Process

Unlabeled Long Axis View of the Bicipital Groove

Labeled Long Axis View of the Bicipital Groove

#7 - Video

#8 - Video

Interpretation

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