The long head of biceps at the shoulder: a scoping review
BMC Musculoskeletal Disorders volume 24, Article number: 232 (2023)
This review aimed to explore the available literature to update our understanding of the long head of biceps (LHB) at the shoulder. Synthesise our findings to identify emergent themes and knowledge gaps to inform future research and management directions.
PubMed, Embase, Cinahl, SportDiscus, CENTRAL, and Web of Science were searched from inception to 31st December 2021. Articles were included if they referenced adult participants > 18 years of age and were written in English.
214 articles were included in the final analysis, and results were categorised into six emergent themes: (1) Anatomy - Normal anatomical variation of the biceps from aberrant origins, third and fourth accessory heads, and an absence of the LHB tendon (LHBT) are not necessarily benign, with shoulder pain and instability a commonly reported theme. (2) Function - Bicep’s role in glenohumeral elevation and stability in healthy shoulders is minimal. In contrast, LHB has a more significant role in shoulder stability and humeral head depression in subjects with rotator cuff failure or an absent LHBT. (3) Pathology - There is an association between LHB tendinopathy, rotator cuff disease, LHBT instability and occult rotator cuff tears. Early recruitment and hyperactivity of the LHB in subjects with symptomatic rotator cuff tears and instability suggest a potential compensatory role. (4) Assessment - The limited diagnostic utility of special orthopaedic tests in assessing LHBT pathology was a consistent theme. The utility of magnetic resonance imaging and ultrasound to identify full-thickness tendon tears and instability of the LHBT was moderate to high. However, the utility of clinical tests and imaging may be underestimated due to arthroscopy’s limitations in fully visualising the proximal LHBT. (5) Non-Surgical Management - Ultrasound-guided injections into the biceps sheath show greater accuracy and patient outcomes than blinded injections; however, the entry of injectate into the intraarticular glenohumeral joint may have unwanted complications. (6) Surgical management - For the surgical management of biceps pathology with or without rotator cuff pathology, both biceps tenodesis and tenotomy report similar improvements in pain without any significant adverse effect on strength or function. Tenodesis favoured higher overall constant scores and a lower incidence of Popeye deformity and cramping arm pain, with tenotomy trending to be more cost and time effective. For patients with a healthy LHBT, rotator cuff repair with adjunctive tenodesis or tenotomy fails to provide additional clinical improvements compared to rotator cuff repair in isolation.
The scoping review highlights the variability of biceps anatomy, which is not necessarily benign and suggests a minimal role of the LHB in shoulder elevation and stability in healthy individuals. In contrast, individuals with rotator cuff tears experience proximal humeral migration and demonstrate hyperactivity of the LHB, suggesting a potential compensation role. The observed prevalence of LHBT pathology with rotator cuff tears is well established; however, the cause-and-effect relationship between LHBT pathology and rotator cuff disease is undetermined. The diagnostic utility of clinical tests and imaging to exclude LHBT pathology may be understated due to the limitations of arthroscopy to visualise the proximal LHBT fully. Rehabilitation programs for the LHB are understudied. Similar post-surgical clinical outcomes are observed for tenodesis and tenotomy for biceps and rotator cuff-related shoulder pain. Subjects undergoing biceps tenodesis are less likely to have cramping arm pain and a Popeye deformity than patients undergoing biceps tenotomy. The significance of routine surgical removal of the LHBT and sequelae on rotator cuff tear progression to failure and long-term shoulder function is unknown, and further research is required.
The purpose of the Long Head of the Biceps (LHB) at the shoulder is an enigma. Its functional role at the shoulder and its contribution to glenohumeral joint arthrokinematics and stability remain poorly understood [1, 2]. Assessment of shoulder tendon pathology remains a clinical challenge due to the historically poor diagnostic utility of individual Orthopaedic Special Tests . Generic management principles for shoulder pain typically include conservative treatment [1, 2, 4]. Often, specific physical therapy interventions and rehabilitation for the non-operative treatment of LHB-related shoulder pain are under-investigated.
In contrast, there is a plethora of literature on the surgical management (tenodesis vs. tenotomy) of LHB-related shoulder pain. Often surgical recommendations for routine LHB tenodesis/tenotomy with rotator cuff tears are dubious because the functional role of the LHB at the shoulder remains uncertain [5, 6]. Consequently, the impact of adjunctive LHBT surgery in rotator cuff-related shoulder pain on shoulder function remains a clinical quandary, with the longer-term implications for shoulder function and rotator cuff disease progression unknown.
Other fundamental questions about the LHB also remain unanswered. With the relationship between proprioception deficits at the shoulder and glenohumeral joint instability still unclear , perhaps the proprioceptive contribution of the LHB to the shoulder is desirable and worth retaining. Conversely, as previous reviews report normal anatomical variations of the LHBT, including a congenital absence , the LHBT may be considered vestigial, equivalent to the palmaris longus tendon of the wrist, implying its removal when pathognomonic lesions to be justified.
In summary, the function of the LHB at the shoulder remains poorly understood. Whilst previous narrative reviews [1, 2] provide a general overview of the LHB. A Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) research methodology and priori protocol in these historical reviews were lacking. They may represent an elevated risk of biased assessment [9, 10]. In addition to providing an update of the current literature, a scoping review protocol was chosen to; (a) explore the extent of available literature through a systematic PRISMA research methodology to decrease error and increase the reliability of assessment findings, (b) thoroughly investigate and synthesise the evidence into emergent themes, and (c) update our current understanding of the function of the LHB at the shoulder to inform future research and management directions. To our knowledge, this is the first scoping review on the LHB at the shoulder.
Objective and research questions
The objectives of this review were: 1) review the research on (a) normal anatomy and function of the LHB at the shoulder, (b) abnormal pathology and assessment findings of the LHBT, (c) non-surgical and surgical management options for LHB-related shoulder pain and (d) functional impacts and disease sequelae of routine LHBT surgery in the operative management of rotator cuff related shoulder pain 2) synthesise findings, and 3) identify emergent themes and knowledge gaps for future research.
A priori protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR): Checklist (Supplementary Table 1) and explanation . This protocol was pre-registered with the Open Science Framework (OSF) https://osf.io/erh9m on September 12, 2021.
The scoping review was guided by the methodology framework developed by Arksey and O’Malley , later refined by Levac, Colquhoun , Peters, Godfrey , Peters, Marnie  using a five-step search strategy of selected databases. (1) Identifying the research question; (2) Identifying relevant studies; (3) Selecting studies; (4) Charting the data, collating, and summarising; and (5) Reporting the results.
Data sources and searches
The lead author (BD) undertook an initial pilot search of PubMed and Google scholar to identify articles on the topic and map key concepts. To develop a complete search strategy, synonyms were identified from text words in the titles and abstracts of relevant articles and the index terms used to describe the articles. A comprehensive search strategy, including all identified keywords and subject/index terms, was developed for PubMed and adapted using Polyglot  for all databases (PubMed MEDLINE, Embase, Cinahl, SportDiscus, CENTRAL, and Web of Science) by the lead investigator in consultation with a research university librarian (See Additional file 2). Following the search from inception to 31st December 2021, all citations were uploaded into EndNote 20.0.1 and duplicates were removed.
Titles and abstracts of eligible studies were screened against the inclusion criteria by the lead author (BD). Potential studies were retrieved in full text and assessed in detail against the eligibility criteria for inclusion in the scoping review. Full-text studies that did not meet inclusion criteria were excluded, and the reasons for exclusion were recorded and reported in the PRISMA Flow Diagram - Fig. 1 (See Additional file 3). All citations and references within selected studies were screened to identify additional studies for inclusion. The selection of studies was guided by the Participants-Concept-Context framework as recommended by the Joanna Briggs Institute (JBI) Methodological Guidelines for scoping reviews .
The study population was defined as adults (18 years or older) regardless of gender, a commonly used cut-off to distinguish the point between adolescence and adulthood.
Any published peer-reviewed literature reporting on the LHB’s role, function, or management at the shoulder and their outcomes.
Context and eligibility criteria
All full-text research articles produced in any year were eligible for inclusion. Exclusion criteria were defined as (1) non-English language, (2) no access to full text and (3) grey literature, including narrative literature reviews, thesis/dissertations, conference abstracts/proceedings, opinion pieces, magazine, and newspaper articles. Morrison, Polisena  found no evidence of a systematic bias from excluding languages other than English in a systematic review-based meta-analysis in conventional medicine.
Whilst the use of a critical appraisal tool was not required for this scoping review (Johanna Briggs Institute Reviewers’ Manual (2017) – Methodology for JBI scoping reviews [11, 12, 17]. The level of evidence for the 214 articles was independently assessed by the lead author (BD) using the JBI - levels of evidence guidelines and supporting documentation . The level of evidence was verified by a blinded second assessor (HK), with eighteen discrepancies resolved with the assistance of a co-author (WH).
Data from publications meeting eligibility criteria were extracted into customised tables. The data extraction tables were modified and revised iteratively during screening for each included study. Data charted in the final extraction tables included the author’s citation details, year of study, level of evidence and key study findings.
Data analysis and synthesis
Studies were initially categorised according to three main domains (1) normal, (2) abnormal and (3) management. Key study characteristics and raw data were tabulated for each domain. Synthesis of key findings was performed to identify emergent themes and key concepts.
Selection of sources of evidence
The search results are displayed in the PRISMA Flow Diagram - Fig. 1 (See Additional file 3). The search strategy generated 6031 results. Following duplicate removal and title and abstract screening, 425 full-text articles were reviewed for inclusion in the study and sixty-two additional records were identified through reference list searches totalling 487 full-text articles. Of these, 273 were excluded, and 214 articles were included in this scoping review.
Characteristics of sources of evidence
The years of publication for included studies ranged from 1948 to 2021, with 2014 to 2021 producing the most publications (Table 1). Studies were categorised into emergent themes; (a) anatomy, (b) function, d) pathology, e) assessment and f) management. Emergent themes were further dichotomised into sub-themes and by the level of evidence (Table 2).
The normal origin of the Long Head of the Biceps (LHB) has traditionally been from the supraglenoid tubercle and superior labrum, with its proximal tendon tracking distally through the rotator cuff interval where the biceps pulley envelops it and houses within the biceps groove. Upon exiting the biceps pulley, it travels under the transverse humeral ligament, where it joins the short head of the biceps to form the biceps brachii muscle belly, sharing a common distal tendon attachment onto the radial tuberosity ligament . Thirty-six articles in Supplementary Table 2 include normal anatomical variations of the biceps brachii and the impact of aberrant origins, supernumerary accessory heads and a congenital absence of the LHBT on shoulder pain and function. Supplementary Table 3 includes three studies on the normal anatomy of the transverse humeral ligament.
Of the thirty-nine articles on biceps brachii anatomy found, thirty-six papers reported anatomical variations from normal. Supplementary Table 2 details the reported variants by type and number. The most common observed anatomical variations pooled across all 36 studies included a) aberrant origins (n = 136), supernumerary accessory heads (n = 98) and LHBT absence (n = 48). The most common aberrant origin of the LHB at the shoulder was the presence of a bifurcate tendon origin in seven articles and an anomalous LHBT origin from the supraspinatus in six articles. A trifurcate origin of the LHBT was seen in three studies, with a solitary case of Chondroepitrochlearis and an LHBT traversing through a bifid Subscapularis found in one paper. Nine studies reported the presence of a third supernumerary head in forty-nine shoulders, and two reported a four-headed biceps variant in nine shoulders. The overall reported prevalence of anatomical variations of the biceps brachii in the case study series ranged from 2.2 to 70% [28, 34, 36, 57, 58, 86, 113, 163], as detailed in Supplementary Table 2. Three studies reported no distinct anatomical structure of the transverse humeral ligament to support a role in LHBT stability in the bicipital groove, as detailed in Supplementary Table 3.
Impact of variation
Of the twenty individual case studies in Supplementary Tables 2, fourteen reported shoulder pain associated with the anatomical variation, an association between pain and aberrant origins in nine studies and pain and LHBT absence in five studies. In four case studies, three articles reported shoulder instability associated with an absence of the LHBT and shoulder instability and weakness in one case study. Shoulder instability and pain were reported in five articles, associated with aberrant origins in two case studies and LHBT absence in three case studies. Two articles observed a single aberrant origin and absent LHBT associated with shoulder pain and restriction of movement in two case studies. A solitary case study observed a Partial Articular-sided Supraspinatus Tendon Avulsion (PASTA) in two patients with an anomalous origin of the LHBT from the Supraspinatus. Two large case series studies and a single systematic review reported a positive correlation between (a) observed anatomical variances of the LHBT origin and the presence of anterosuperior labral fraying (odds ratio, 3.58; p = 0.000), abnormal superior glenohumeral ligament (odds ratio, 3.69; p = 0.012) , and (b) LHBT absence and the presence of shoulder pain (85.7%) and instability (37.1%) . Whilst shoulder joint instability was more prevalent in biceps variations in the mesotenon; it did not reach significance (27.6%: 14.9%, p = 0.305) .
In this section of LHB function at the shoulder, forty-seven articles were categorised under the subthemes of (a) biceps electromyography, (b) shoulder biomechanics (Supplementary Table 4), (c) shoulder stability in vivo (Supplementary Table 5), (d) glenohumeral joint arthrokinematics in vitro (Supplementary Table 6), and (e) shoulder proprioception as detailed in Supplementary Table 7.
Twenty-seven studies used electromyography (EMG) to investigate the activity of the biceps brachii, as detailed in Supplementary Table 4. Thirteen studies differentiated long head vs. short head of biceps activity. Sixteen studies used surface electromyography (sEMG) to record biceps brachii activity during functional tasks of the shoulder [21, 29, 42, 44, 70, 83, 84, 103, 112, 114, 116, 117, 121, 159, 190, 213]. Four studies used fine wire electromyography (fwEMG) to record biceps brachii muscle activity [20, 23, 25, 51]. Seven studies used a combination of both sEMG and fwEMG for recording activity of the biceps brachii and other shoulder muscles, such as the rotator cuff and deltoid muscles [40, 46, 52, 101, 102, 120, 228].
Thirteen articles detailed in Supplementary Table 4 investigated the role of the LHB in healthy shoulders. Six studies demonstrated LHB muscle activity during shoulder elevation [20, 21, 44, 70, 103, 116]. Three studies validated LHB activity during overhead throwing and bowling [23, 84, 114]. In contrast, four studies supported no significant LHB activity during shoulder elevation [40, 52, 101, 121]. Studies using an elbow brace or elbow flexor fatigue protocol to minimise biceps function at the elbow confirmed an active role of the LHB during shoulder elevation in two studies [44, 116].
In contrast, three studies found no significant or minimal activity of the LHB during shoulder elevation [40, 52, 121]. Two studies of biceps brachii activity during common therapeutic shoulder exercises demonstrated the highest biceps activity in the sagittal plane, during unsupported elbow flexion and supination, from an extended position (e.g., shoulder extension) or during high-velocity explosive exercises such as underarm throwing [117, 159]. Two studies reported more significant activity and strength production of biceps brachii during biceps curl variations in shoulder elevation [83, 112]. One study reported more significant biceps brachii activity during isometric shoulder external rotation in sitting than supine. One study supported a pre-activation and a pre-setting role of the LHB and rotator cuff during shoulder rotation at 45° scaption in normal asymptomatic subjects .
Six in vivo studies examined the role of the biceps brachii in shoulder stability, as detailed in Supplementary Table 5. Five studies support a role in glenohumeral joint stability and humeral head depression [37, 47, 56, 65, 78] and a single study reported a minor role in shoulder stability . Active humeral head depression at the shoulder by the biceps brachii in patients with rotator cuff lesions was observed under radiology assessment in one study . A large study by Walch, Edwards  of 291 patients undergoing LHB tenotomy for irreparable full thickness tears of the rotator cuff demonstrated a significant superior migration of the head of the humerus following tenotomy. A single case report of incidental arthroscopy findings of LHBT absence reported an association with shoulder instability which improved after thermal capsulorraphy . A study of seven patients with an LHBT absence under arthroscopy/MRI demonstrated superior glenohumeral translation in shoulders compared to intact shoulders . One study of thirty asymptomatic volunteers showed a dynamic role of the LHB in glenohumeral joint stability during low angles of shoulder elevation < 30° . In contrast, a study of five patients undergoing biceps tenodesis for chronic biceps tenosynovitis demonstrated no significant alterations in glenohumeral joint position or activity after LHB tenotomy compared to healthy shoulders .
Glenohumeral joint arthrokinematics
Thirteen in vitro cadaver studies detailed in Supplementary Table 6 examined the role of the LHB in intact shoulders and six articles with simulated shoulder injuries, including rotator cuff tears, Bankart and superior labral lesions [30,31,32, 35, 88, 94]. Ten studies demonstrated a shoulder stability role for the LHB [30,31,32, 35, 38, 85, 88, 94, 106, 153]. Six studies demonstrated a humeral head depressor role [27, 38, 50, 88, 106, 153]. One study demonstrated a glenohumeral joint compressor role . The observed and often stated limitations of the cadaver studies found included rationales to determine appropriate biceps forces in vitro that accurately represent the normal physiological loads of the LHB in vivo. Three studies used a biceps load of 55-N force, predicted from the Physiological Cross-Sectional Area (PCSA) of the biceps brachii [35, 38, 88]. Two studies used progressive biceps loads of 10, 20 and 40-N based on previously published PCSA values [100, 153]. A single study used %PCSA (55-N) to determine a passive 5 N (10%) and active 25 N (50%) biceps preload . A single study used PCSA to determine physiological biceps loads with no reported values stated . Two studies used a biceps load of 1.5 and 3 kg  and 1.5 kg , proportional to PCSA. Two studies used a 3 kg  and a 20-N  simulated biceps load with no reported rationale. Two studies calculated physiological biceps loads using a combination of PCSA and EMG percentage of a maximal voluntary contraction during a functional task, e.g., throwing [32, 85].
No direct evidence for or against the role of the LHB in proprioception at the shoulder was found. Two systematic reviews on proprioception and shoulder pain/pathology were found. Ager, Borms  reported moderate evidence for an affected sense of kinaesthesia and insufficient evidence for an impaired sense of force amongst painful shoulders. Fyhr, Gustavsson  reported deficits in movement sense and passive joint reposition sense following post-traumatic shoulder instability compared to the contralateral uninjured shoulders and controls, as detailed in Supplementary Table 7.
Thirty-five diagnostic studies in Supplementary Tables 8 and eight EMG studies, as detailed in Supplementary Tables 9, were categorised under the sub-themes of LHBT pathology, rotator cuff pathology and compensation.
Long head of biceps pathology
As detailed in Supplementary Tables 8, common LHBT pathologies include tendon instability, tendinopathy (ruptures, tears, lesions, tendinitis, sheath effusions), bicep pulley lesions, bicipital groove dysplasia, labral variants/SLAP lesions and an absence of LHBT. Observed biceps pathology associated with the LHB’s anatomical variations involved anterosuperior labrum variants, a Buford complex, SLAP lesions, and biceps instability [53, 77, 205, 227]. Other pathological associations included; (a) LHBT pulley lesions and degenerative LHB tendinopathy with biceps instability and degenerative glenohumeral joint disease , (b) LHB tendinitis and pro-inflammatory mediators, neovascularisation, and gene expression , (c) absent LHBT and shoulder pain , (d) LHBT rupture, instability with shoulder pain and permanent elbow/forearm strength and endurance loss , and LHBT tears with occult distal biceps lesions extending beyond the biceps groove (Supplementary Table 15) .
Rotator cuff pathology
Concomitant rotator cuff pathology associated with LHB tendinopathy includes rotator cuff tears, Supraspinatus and Subscapularis tears, Supraspinatus tendinopathy and rotator cuff tendinopathy. A high association was observed between LHBT instability and rotator cuff pathology in twelve articles, inclusive of Subscapularis tears in eight articles [61, 98, 137, 152, 178, 195, 196, 203], isolated Supraspinatus tears and Subscapularis tears in two studies [24, 227] and rotator cuff tears in two studies [45, 75]. A lower association was observed between the incidence of biceps pulley lesions and rotator cuff tears, SLAP lesions, anterosuperior impingement and increasing age . Absence of the LHBT with rotator cuff tears . Biceps groove morphology with LHBT instability and Subscapularis tendinopathy [157, 158]. LHBT sheath effusion and rotator cuff tears  and increased cross-sectional area of LHBT with rotator cuff tears  as detailed in Supplementary Table 8.
Eight EMG studies were found directly supporting increased muscle activation of the biceps brachii in the presence of rotator cuff pathology and shoulder instability, as detailed in Supplementary Table 9. Two studies demonstrated significant hyperactivity of the biceps brachii compared to control groups in the presence of rotator cuff tears during reaching and shoulder elevation tasks [42, 102]. A single study reported a significant delay in anticipatory muscle activation in subjects with rotator cuff tears during a ball drop task . A recent study demonstrated both hyperactivity and pre-activation of the biceps brachii in patients with rotator cuff tears during reaching tests . In support of biceps activity during throwing, two studies reported significant hyperactivity of the biceps brachii during simulated pitching and cocking phases of throwing in subjects with anterior shoulder instability vs. controls [25, 51]. In contrast to the observed changes in muscle activity with rotator cuff pathology, two studies reported no significant differences in (a) biceps brachii activity with the elbow immobilised in a brace during shoulder range of motion in patients with rotator cuff tears vs. controls  and (b) in activity or fatigue of the biceps brachii during a gripping task in patients with rotator cuff tears .
Assessing the LHBT in the clinical examination can be completed in several ways. Fifty articles investigating the assessment of the LHBT pathology at the shoulder were categorised into several sub-themes, including (a) screening questionnaires and (b) clinical examination (Supplementary Tables 10, 11 and 12), (c) diagnostic imaging such as magnetic resonance imaging/arthrography (Supplementary Table 13) and ultrasound, (d) diagnostic injections (Supplementary Table 14) and (e) arthroscopy (Supplementary Table 15).
As detailed in Supplementary Tables 10, a single study established a clinical examination algorithm for the standardisation of shoulder assessment, including the differential diagnosis of biceps pathology . Three studies examined the clinical utility of a symptom modification approach to diagnosing and managing shoulder musculoskeletal conditions, including Rotator cuff and LHB-related shoulder pain. Of two studies on the Shoulder Symptom Modification Procedure (SSMP), one  found high inter-rater reliability. Yet, the authors acknowledged that the efficacy of the Shoulder Symptom Modification Procedure (SSMP) in treating shoulder pain was yet to be established. The other more recent study  reported moderate inter-rater reliability but found the association between within-session and between-session changes in pain regarding treatment efficacy for the Shoulder Symptom Modification Procedure (SSMP) to be insufficient. The authors consequently concluded that the Shoulder Symptom Modification Procedure (SSMP) was not reliable or valid for managing shoulder pain. A single study of a symptom modification test cluster for shoulder instability reported a significant, meaningful relationship between GIRD - glenohumeral internal rotation deficit and an impingement GIRD apprehension-relocation test cluster .
Several systematic reviews and diagnostic studies examined the validity of traditional and contemporary Orthopaedic special tests for LHBT pathology with considerable variability found, whilst two studies showed a limited diagnostic yield of bicipital groove tenderness for LHB tendinopathy [73, 169], as detailed in Supplementary Table 11. Three high levels of evidence studies supported the use of test clusters to improve their diagnostic yield (biceps groove palpation, Speed’s, Yergason’s and Uppercut test) with higher diagnostic utility demonstrated when performed in combination with diagnostic ultrasound (Supplementary Table 12) [81, 169, 183].
Magnetic resonance imaging and arthrography
Eighteen studies were found investigating the validity of Magnetic Resonance Imaging (MRI) and Arthrography (MRA), compared with arthroscopic surgery in seventeen of the eighteen studies found diagnosing proximal LHBT pathology at the shoulder, exclusive of SLAP lesions and labral pathology as detailed in Supplementary Table 13. Overall diagnostic accuracy, specificity, and sensitivity values for MRA were superior to MRI for LHBT pathology, though, the difference was negligible. Both diagnostic utilities varied considerably for LHB tendinopathy, including tears, tendinitis, tendinosis, instability, and pulley lesions. There was an overall trend for low sensitivity and high diagnostic accuracy and specificity values for the exclusion and detection of full thickness and complete tears of the LHBT for both MRI and MRA, respectively, compared with low specificity and sensitivity values to rule in and out partial thickness tears of the LHBT [60, 90, 118, 139, 150, 155, 180, 188]. LHBT instability demonstrated variable specificity, and sensitivity values with a trend for higher specificity values to rule in dislocation of the LHBT compared with subluxation, whilst the sensitivity values in many of the studies identifying LHBT instability were poor [60, 90, 118, 134, 139, 150, 155, 165, 180, 188]. In a single systematic comparison of MRI and MRA, MRA demonstrated higher specificity for detecting LHBT appearance and position than MRI . A single study of biceps pulley lesions on MRA compared with arthroscopy reported high accuracy, sensitivity, and specificity values for MRA . Contrary to clinical intuition, a single study of the impact of Body Mass Index (BMI) on MRI accuracy demonstrated significantly higher diagnostic accuracy of MRI for the detection of Bankart lesions in both overweight and obese patients when compared with patients with a healthy Body Mass Index (BMI) (Supplementary Table 10) .
Ten studies examined the validity of diagnostic ultrasound in detecting LHBT pathology compared with arthroscopy in four studies, arthroscopy/open surgery in two, arthroscopy/arthrotomy in one and MRI in two studies, as detailed in Supplementary Table 14. Two articles reported high specificity and sensitivity values for ruling in and out full-thickness tears. In comparison, there was an observed trend for lower sensitivity values to rule out partial thickness tears of the LHBT [67, 95]. Two studies demonstrated variable specificity and sensitivity for complete tears [128, 181]. Two studies showed high specificity for LHBT rupture [49, 181]. Biceps instability demonstrated an overall trend for increased specificity and sensitivity values for ruling in and out dislocation > subluxation of the LHBT [43, 49, 67, 128, 181]. The specificity of diagnostic ultrasound to rule in tendinitis was high, and its sensitivity to rule out tendinitis was low [43, 110]. A single cross-sectional study comparing the diagnostic accuracy of ultrasound vs. MRI in detecting LHBT pathology to arthroscopy showed a trend for higher specificity for MRI compared to diagnostic ultrasound for identifying proximal LHBT pathology. Sensitivity values for both remained poor .
A single study on diagnostic injections for LHBT pathology reported high specificity but low sensitivity to exclude LHBT pathology . A cadaver study by Gofeld, Hurdle  demonstrated the spread of injectate from the biceps sheath into the glenohumeral joint and cartilage in 92% of specimens suggesting the limited diagnostic utility of injections for LHB pathology as detailed in Supplementary Table 14.
Supplementary Table 15 detailed four clinical studies that presented findings of LHBT pathology (lipstick sign, sentinel sign, chondral print, and the ramp test). One study reported the presence of a detour sign on MRI as a useful clinical indicator of LHBT subluxation, occult Subscapularis, and Supraspinatus rotator cuff pathology . Arthroscopic surgery as a standard gold reference for confirmation of LHBT pathology at the shoulder was used in most diagnostic and imaging studies, as detailed in Supplementary Tables 11, 12, 13, and 14. In Supplementary Tables 15, the limitations of arthroscopy to fully evaluate the proximal intra-articular LHBT-labral complex and identify occult extra-articular bicipital tunnel lesions were reported in four articles [119, 132, 140, 164].
In this section of Management, forty-one articles were categorised under non-surgical (Supplementary Tables 16 and 17) and surgical management. Surgical management was further dichotomised into operative intervention for (a) LHBT-related shoulder pathology (Supplementary Table 18), (b) rotator cuff-related shoulder pathology (Supplementary Table 19) and (c) rotator cuff and LHBT-related shoulder pathology, as detailed in Supplementary Table 20.
Supplementary Table 16 details our limited findings of four articles reporting on the non-surgical management of LHB-related shoulder pain. A single paper presented a care pathway for shoulder pain management, including LHBT management in primary care . Two EMG studies demonstrated a progression of biceps-targeted activity from least active to most active during common shoulder rehabilitation exercises in healthy subjects [117, 159]. A single study by McDevitt, Snodgrass  demonstrated support for including dry needling, eccentric, concentric exercise, and biceps brachii stretching for managing chronic LHB tendinopathy.
Seven studies investigated the injection of dye, local anaesthetic, and corticosteroid into the LHBT sheath (Supplementary Table 17). None compared injection with no injection or placebo. Six reported greater accuracy and pain relief when injections were guided by ultrasound or fluoroscopy than unguided injections [91, 93, 97, 126, 210, 232]. One cadaver study found a high rate of dye migration into the glenohumeral joint capsule and the potential for wanted or unwanted deposition of injectate into the intra-articular glenohumeral joint . One article compared non-surgical care versus tenodesis for LHBT ruptures. Patients managed non-surgically tend to return to work quicker but at lesser capacity and with less elbow flexion and forearm supination strength than patients who underwent biceps tenodesis . One systematic review reported common surgical indications for tenodesis, including LHBT tears, instability, and tenosynovitis .
In total, thirty-five articles compared postoperative outcomes in patients undergoing LHB tenodesis versus tenotomy, with tenodesis the most common procedure reported (n = 9983) vs. tenotomy (n = 6855). Twenty-two articles examined LHB tenodesis and tenotomy outcomes in subjects with LHBT-related shoulder pathology in isolation (Supplementary Table 18). Six articles investigated the effects of adjunctive LHBT surgery in subjects with rotator cuff-related shoulder pathology (Supplementary Table 19), and seven articles reported tenodesis and tenotomy outcomes in subjects with concomitant rotator cuff and LHBT-related shoulder pathology, as detailed in Supplementary Table 20.
Surgery for LHBT pathology
For subjects undergoing tenodesis vs. tenotomy for LHBT-related shoulder pathology, the overall postoperative Patient Reported Outcome Measures (PROMS) were similar for both tenodesis and tenotomy, across the twenty-two articles found, with a minor trend for improved constant scores in favour of tenodesis in three articles [131, 194, 224]. A higher prevalence of Popeye deformity in fourteen articles and cramping arm pain in six were observed in patients who undertook tenotomy vs. tenodesis, as detailed in Supplementary Table 18. Decreased post-operative narcotic use and quicker pain relief was observed in one article for patients following biceps tenotomy , with longer surgical times observed in patients post-tenodesis . Three studies that dichotomised their results by patient demographics showed a greater incidence of Popeye deformity in male patients , with less satisfaction in younger male patients following tenotomy compared with tenodesis . Male gender, younger age, and active worker’s compensation were associated with increased complications following tenotomy . For articles comparing LHB tenodesis vs. tenotomy for LHBT or SLAP pathology, similar trends were observed, with no significant differences in postoperative PROMS for pain, function, and strength [197, 215, 216]. However, a more significant trend was observed for increased shoulder flexion range of motion (ROM) and less postoperative stiffness in patients who undertook open compared with arthroscopic tenodesis . One article by Horan, Dekker  comparing SLAP repair vs. biceps tenodesis in young overhead-throwing athletes demonstrated PROMS with a high rate of return to overhead-throwing sports. Similar strength scores were reported across all studies, apart from two articles reporting subjective biceps weakness at the elbow following tenotomy [92, 204]. A comparison of arthroscopic vs. open tenodesis reported greater postoperative shoulder flexion for patients who underwent open tenodesis . Post-surgical follow-up in the twenty-two articles was highly variable, ranging from 3 months to 13 years, with many studies reporting a mean follow-up time ≥ two years. Result findings are medium-term and likely to represent post-surgical outcomes over time.
Adjunctive surgery on a healthy LHBT for rotator cuff pathology
Of the six articles reporting outcomes of adjunctive biceps surgery for repairable and irreparable rotator cuff tears, similar levels of patient satisfaction and PROMS were observed across all studies, as detailed in Supplementary Table 19. Two articles comparing post-operative clinical outcomes of patients undertaking either tenodesis or tenotomy for irreparable rotator cuff tears without rotator cuff repair reported high levels of patient satisfaction and PROMS [65, 71]. Of the four articles investigating adjunctive tenodesis or tenotomy with rotator cuff repair, higher surgical costs were reported in patients who underwent (a) rotator cuff repair with adjunctive tenodesis compared with adjunctive tenotomy or rotator cuff repair in isolation and (b) arthroscopic tenodesis compared with open biceps surgery [218, 222]. There was a trend for a higher incidence of Popeye deformity in three articles [71, 133, 154] and cramping arm pain in one article  for patients who underwent tenotomy. An article by Meraner, Sternberg  reported greater postoperative shoulder abduction strength in patients who underwent rotator cuff repair with adjunctive tenodesis compared with tenotomy. In addition to the six articles discussed, one clinical trial by Godenèche, Kempf , Supplementary Table 20 compared clinical outcomes following tenodesis or tenotomy in subjects with Supraspinatus rotator cuff tears and no LHBT pathology (normal) vs. Supraspinatus rotator cuff tears with LHBT pathology over a 10-year follow-up period. For patients with a healthy LHBT, similar constant scores were reported between Supraspinatus repair in isolation and Supraspinatus repair with either adjunctive tenodesis or tenotomy. The authors concluded that adjunctive LHBT surgery with Supraspinatus repairs should be avoided intraoperatively in patients with a normal LHBT. In the seven articles, post-surgical follow-up times ranged from 12 months to 10 years. Except for one 10-year study, most studies reported a mean follow-up time of ≤ 3 years. Result findings were, therefore, medium to long-term and likely represented stable post-surgical outcomes over time.
Surgery for rotator cuff and LHBT pathology
As detailed in Supplementary Tables 20, seven articles reported postoperative outcomes in subjects with concomitant rotator cuff and LHBT-related shoulder pathology. Five articles reported similar post-operative clinical results in subjects who undertook routine rotator cuff repair and adjunctive tenodesis or tenotomy, with a trend for higher constant scores in patients who undertook tenodesis [19, 142, 147, 170, 225]. Again, there was a trend for a higher incidence of Popeye deformity in three articles [147, 170, 225] and cramping arm pain in two papers [147, 225] in patients who underwent tenotomy with similar rotator cuff repair rates observed. Shorter operative times were observed in patients who underwent rotator cuff repair in isolation compared with patients who underwent rotator cuff repair and adjunctive tenodesis . For subjects with a concomitant Supraspinatus tear and confirmed intraoperative LHBT pathology, Godenèche, Kempf  reported higher constant scores for function and strength in patients who underwent Supraspinatus repair with either adjunctive LHB tenodesis or tenotomy, compared with patients who underwent isolated Supraspinatus repair. Similar higher PROMS in subjects undergoing rotator cuff repair and adjunctive tenodesis or tenotomy compared with rotator cuff repair in isolation were observed in another article . A study of patients with concomitant rotator cuff tears and SLAP lesions reported similar clinical outcomes in PROMS and shoulder ROM for patients who undertook rotator cuff repair with SLAP repair vs. subjects who undertook rotator cuff repair with adjunctive tenodesis . Post-surgical follow-ups ranged from 1 month to 10 years, with most studies reporting a mean follow-up time ≤ to 4 years. Pooled result findings are medium-term and highly likely to represent post-surgical outcomes over time.
Our scoping review observed considerable anatomical variation of the LHB from double or triple tendon aberrant origins and supernumerary third and fourth accessory heads to a congenital absence of the LHBT. These observed variations were associated with higher shoulder pain and instability prevalence. Morris, Guettler  and Kanatli, Ozturk  reported similar observations, concluding that anatomical variations of the LHB are not always benign. The role of the transverse humeral ligament in LHBT stability was unclear, with the literature invalidating the transverse humeral ligament as a distinct anatomical structure. The growing consensus in the literature supports the biceps pulley as the primary stabiliser of the LHBT in the bicipital groove .
The role of the biceps brachii at the elbow joint and its contribution to elbow flexion and forearm supination is well documented and understood in the literature . Our scoping review found a lack of consensus for an active role of LHB at the shoulder during shoulder elevation and throwing activities, with a minor role in shoulder stability in normal healthy shoulders. In contrast, we found an established humeral head depressor function at the shoulder in (a) subjects with rotator cuff tears and shoulder instability, (b) in patients following adjunctive LHB tenotomy for irreparable rotator cuff tears, (c) in patients with an absent LHBT and (d) during physiological loading of the biceps brachii in cadaver shoulders with simulated rotator cuff and labral lesions. The role of the LHB in proprioception at the shoulder was underdetermined. Our scoping review found that both sEMG and fwEMG can be used effectively to investigate biceps brachii and LHB activity. Chalmers, Cip  established that both the long and short heads of the biceps brachii have separate muscular fibres and can be studied effectively through sEMG. Marri and Swaminathan  confirmed the usefulness of sEMG analysis of the biceps brachii in training and rehabilitation programs.
There was an established association between LHB tendinopathy and rotator cuff pathology and LHBT instability and occult Subscapularis tears in our scoping review, with EMG studies demonstrating hyperactivity of LHB in the presence of rotator cuff tears and shoulder instability, suggesting a compensation role of the LHB in pathological shoulders. Similar changes in muscle activation of the deep abdominal muscles have been established in people with chronic low back pain [237,238,239]. Our conclusions agree with Khandare, Arce  and Kaar  that further research is required to determine if the LHB muscle compensates for rotator cuff pathology and shoulder instability. We hypothesise that the increased biceps activity observed in patients with rotator cuff deficiency may explain the high prevalence of concomitant LHBT pathology with rotator cuff disease severity as it attempts to compensate for rotator cuff deficiency at the shoulder. Occult Subscapularis tears typically occur when biceps sling integrity is compromised, displacing the unstable LHBT anteromedially into the Subscapularis tendon, leading to subsequent tearing [242,243,244]. Other potential mechanisms of LHB tendinopathy include mechanical constriction and irritation from a bottleneck narrowing of the biceps groove .
The limited diagnostic utility of screening questionnaires, special orthopaedic tests, and palpation in the differential diagnosis of LHBT pathology was a consistent theme in our scoping review. Due to the variable diagnostic utility of special orthopaedic tests of the shoulder [3, 246,247,248,249,250,251,252,253,254,255], it was not surprising that the diagnostic accuracy of special orthopaedic tests to identify LHBT pathology was also highly variable, with the use of test clusters improving test accuracy. The use of a symptom modification approach during the physical examination of the shoulder is contemporary . Our study findings agree with the conclusions drawn by Lehman  that the definitive mechanisms underpinning the symptom modification approach are yet to be fully understood, and more research is required to validate its use in shoulder pain. Proximal LHBT tenderness at the bicipital groove seems to have little utility for diagnosing LHBT pathology.
The American College of Radiology Appropriateness Criteria for Atraumatic Shoulder Pain recommends MRI or diagnostic ultrasound be performed when LHBT pathology is suspected, and initial radiographs are normal or inconclusive. Our scoping review findings support using MRA over MRI to diagnose LHBT appearance, position, and biceps pulley lesions for LHBT pathology. Most MRI and MRA studies reported a high utility for detecting full thickness and complete tears of the LHBT; however, the utility for MR imaging to detect and exclude partial thickness tears of the LHBT was low. Overall MR imaging to detect LHBT instability was found to be variable; though, there was an observed trend for higher specificity to rule in LHBT dislocation compared with subluxation. MRI and MRA sensitivity values were lower than the reported specificity values.
Similar to our MR findings, several studies reported the higher diagnostic utility of ultrasound for biceps dislocation greater than subluxation and the detection of full-thickness tears of the LHBT. However, its ability to identify partial-thickness tears of the LHBT was less accurate. Similar findings were found for diagnosing biceps tendinopathy. Study comparisons between diagnostic ultrasound and MRI reported high specificity values for MRI greater than diagnostic ultrasound for proximal LHBT pathology, but sensitivity values for both were overall poor. A recent literature review by Ostrowski, Beaumont  found similar results with a reported high accuracy of musculoskeletal ultrasound to diagnose LHBT dislocation, subluxation, and full-thickness tears, and less accuracy in diagnosing partial-thickness tears and tendonitis. Arthroscopy was the gold reference standard in most diagnostic tests and imaging studies. The reported limitations of arthroscopy to fully visualise the proximal LHBT at the glenohumeral joint in our scoping review findings may underestimate their reported accuracy and sensitivity values, and more research is required to validate their use in the diagnosis of LHB-related shoulder pain and tendon pathology.
There were limited result findings for the conservative management of LHBT pathology due to the lack of articles found, with subjects managed non-surgically trending to return to work quicker but at lesser capacity and with less elbow/forearm strength than subjects undergoing LHB tenodesis. Similar to our observations, a systematic review by Castro, Corrêa  reported low to very-low-quality evidence to support the conservative management of rotator cuff and biceps tendinopathy-related shoulder pain. Generic rehabilitation principles for tendinopathy typically include progressive muscle strengthening for tendon remodelling and adaption to load [260, 261]. From the anecdotal research we found on biceps activity during common shoulder rehabilitation exercises, a potential LHB rehabilitation exercise program may include a progression of biceps curls into elevation, shoulder front raises in external rotation, elbow extension and supination, and a sport-specific program of overhead to underarm throwing drills. Similar authors have inferred the need for research validating the use of LHB strengthening exercises for rotator cuff-related shoulder pain, shoulder impingement and instability [30,31,32, 38, 50, 85, 88].
This review found no studies that compared LHB injection with no injection, indicating that the current literature does not provide guidance on the efficacy of injection for LHBT pathology. In contrast, a prior review reported that it might give temporary pain relief for inflammatory conditions of the LHBT . If a clinical decision is made to use LHBT sheath injection, our results consistently indicate that image-guided procedures are more accurate and should be preferred over unguided techniques. Injected substances can migrate from the sheath into the communicating glenohumeral joint capsule, exposing the joint to a variety of potential corticosteroid adverse effects, including known catabolic effects on the tendon, ligament, adipose and cartilage tissue [262,263,264]. In addition, high concentrations of commonly used local anaesthetics such as lidocaine and bupivacaine are chondrotoxic [265,266,267]. These risks must be weighed against pain-induced morbidity and progressive shoulder dysfunction associated with LHBT pathology. Until further research clarifies the efficacy of injection compared with other treatment options, clinicians must continue to make clinical decisions based on the individual patient’s circumstances.
For the surgical management of long head of biceps pathology with or without rotator cuff pathology, our scoping review found similar improvements in patient-reported outcomes for pain and function post-operatively for tenodesis or tenotomy, with tenodesis trending towards higher constant scores and tenotomy trending to be more cost and time effective. At the same time, patients undergoing tenodesis were less likely to have post-surgical complications of Popeye deformity and cramping arm pain. A similar trend was observed in a recent systematic review by Aldon-Villegas, Perez-Cabezas , with fewer Popeye signs and cramping arm pain following tenodesis compared with tenotomy. A slight trend was observed for reduced operative time, narcotic use and quicker pain relief in patients undergoing tenotomy. In studies that dichotomised their results by age, less satisfaction was observed in younger male patients following tenotomy compared with tenodesis.
The systematic inclusion of adjunctive LHB tenotomy or tenodesis on a healthy normal LHBT with rotator cuff repair has been reported as an increasing trend in the literature . Our findings support avoiding adjunctive LHBT surgery with rotator cuff repairs in subjects with a normal LHBT because similar clinical outcomes following Supraspinatus repair in isolation vs. Supraspinatus repair with adjunctive biceps tenodesis/tenotomy were found. Similar patient-reported outcome measures (PROMS) in subjects undergoing rotator cuff repair and adjunctive tenodesis or tenotomy compared with rotator cuff repair in isolation were observed by Watson, Robbins . Whether to include routine biceps tenodesis/tenotomy with rotator cuff repair presents a surgical conundrum similar to the standard inclusion of bursectomy with subacromial decompression surgery for subacromial pain syndrome when evidence supports identical clinical outcomes for bursectomy vs. bursectomy with acromioplasty . The question of whether LHB tenodesis or tenotomy should be routinely performed in arthroscopic rotator cuff repairs was recently discussed by Moorthy and Tan , concluding that whilst there is a role for biceps surgery in rotator cuff repair, further higher-level studies are needed to determine if tenodesis and tenotomy should be performed routinely instead of selectively in rotator cuff tears. Goldfarb and Yamaguchi  advocated that routine tenodesis be avoided during operative treatment for rotator cuff tears as LHB tendinopathy may be reversible.
This scoping review was limited to English publications, excluding full-text articles published in other languages. Previous narrative reviews and grey literature were excluded, including conference abstracts and thesis dissertations. The lead author (BD) independently performed the screening, inclusion, exclusion, and data extraction. Whilst the level of evidence for each article was assessed, the methodological quality of the studies was not appraised critically as per guidelines for completing scoping reviews. Articles biased towards rotator cuff pathology and intra-articular SLAP or labral pathology were excluded from this scoping review.
Conclusions and recommendations
The scoping review highlights; (a) Anatomy – Common anatomical variations of the biceps brachii, associated with shoulder pain and instability, a potential role for the biceps sling in LHBT stability with minimal support for the transverse humeral ligament as a separate, distinct anatomical structure. (b) Function - the minimal role of the LHB in shoulder elevation and glenohumeral stability in healthy shoulders. In pathological shoulders, proximal humeral migration, and hyperactivity of the LHB suggest a potential compensation function in individuals with symptomatic rotator cuff tears or shoulder instability. However, changes in LHB muscle activity in subjects with asymptomatic rotator cuff pathology are undetermined. Further research is required in both asymptomatic and symptomatic rotator cuff tear populations to determine whether there is a compensation role of the LHB at the shoulder. (c) Pathology - The prevalence of concomitant LHBT pathology with rotator cuff tears is well established; however, the cause-and-effect relationship between LHBT pathology and rotator cuff disease is undetermined. Further research is required to establish if the LHBT becomes overloaded and, in turn, pathological as it tries to compensate for the loss of function of a torn rotator cuff or is a secondary effect of degenerative shoulder pathology, pain, and weakness. (d) Assessment - The diagnostic utility of both clinical orthopaedic tests and diagnostic imaging to exclude LHBT pathology may be understated due to the inherent limitations of arthroscopy as the standard gold reference to visualise the proximal LHBT at the glenohumeral joint fully. (e) Non-surgical management - Conservative rehabilitation programs of the shoulder that include biceps strengthening protocols are understudied, and the evidence to support the inclusion of LHB rehabilitation in the management of rotator cuff and biceps-related shoulder pain is lacking. Further research is required to understand how a biceps-focused rehabilitation program may improve shoulder pain and functional outcomes in patients with symptomatic rotator cuff tears and b) prevent or reduce the likelihood of an asymptomatic rotator cuff tear becoming symptomatic and progressing to failure. (f) Surgical management - Similar post-surgical clinical outcomes are observed for tenodesis and tenotomy for biceps and concomitant rotator cuff-related shoulder pain, with subjects undergoing biceps tenodesis less likely to have cramping arm pain and a Popeye deformity compared to patients undergoing biceps tenotomy. The significance of routine surgical removal of the LHBT and sequelae on rotator cuff tear progression to failure and long-term shoulder function is unknown, and further research is required.
All data generated or analysed during this study are included in this published article [and its supplementary information files].
Absence of LHB
Krippendorff’s Alpha Coefficient
Level of Evidence
Long Head of Biceps
Long Head of Biceps Tendon
Patient Reported Outcome Measures
Pearson’s Correlation Coefficient
Range of Motion
Rotator Cuff Repair
Short Head of Biceps
Spearman’s Rank Correlation Coefficient
Spearman’s correlation coefficient
Superior Labrum Anterior Posterior
Elser F, Braun S, Dewing CB, Giphart JE, Millett PJ. Anatomy, function, injuries, and treatment of the long head of the biceps brachii tendon. Arthroscopy. 2011;27(4):581–92.
Sarmento M. Long head of biceps: from anatomy to treatment. Acta Reumatol Port. 2015;40(1):26–33.
Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46(14):964–78.
Khazzam M, George MS, Churchill RS, Kuhn JE. Disorders of the long head of biceps tendon. J Shoulder Elbow Surg. 2012;21(1):136–45.
Bollier M, Arciero R, Romeo A, Mazzocca A. Current management of chronic proximal biceps tendinitis. Curr Orthop Pract. 2010;21(1):38–42.
Goldfarb C, Yamaguchi K. The biceps tendon: dogma and controversies. Sports Med Arthrosc Rev. 1999;7(2):93–103.
Lephart SM, Jari R. The role of proprioception in shoulder instability. Oper Tech Sports Med. 2002;10(1):2–4.
Ghalayini SR, Board TN, Srinivasan MS. Anatomic variations in the long head of biceps: contribution to shoulder dysfunction. Arthroscopy. 2007;23(9):1012–8.
Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143.
Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for scoping reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467–73.
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.
Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69.
Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015;13(3):141–6.
Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119–26.
Clark JM, Sanders S, Carter M, Honeyman D, Cleo G, Auld Y, et al. Improving the translation of search strategies using the polyglot search translator: a randomized controlled trial. J Med Libr Assoc. 2020;108(2):195–207.
Morrison A, Polisena J, Husereau D, Moulton K, Clark M, Fiander M, et al. The effect of English-language restriction on systematic review-based meta-analyses: a systematic review of empirical studies. Int J Technol Assess Health Care. 2012;28(2):138–44.
Sucharew H, Macaluso M. Progress Notes: methods for Research evidence synthesis: the Scoping Review Approach. J Hosp Med. 2019;14(7):416–8.
The Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working Party*. Supporting Document for the Joanna Briggs Institute Levels of Evidence and Grades of Recommendation.The Joanna Briggs Institute. 2014. [Available from: (Microsoft Word - JBI-Levels-of-evidence_2014.doc.docx).
Gray H, Williams PL, Bannister LH. Gray’s anatomy : the anatomical basis of medicine and surgery. 38th / chairman of the editorial board, Peter L. Williams ; editorial board, Lawrence H. Bannister … [et al.] ed. New York: Churchill Livingstone; 1995.
Basmajian JV, Latif A. Integrated actions and functions of the chief flexors of the elbow: a detailed electromyographic analysis. J bone joint Surg Am volume. 1957;39–A(5):1106–18.
Furlani J. Electromyographic study of the m. biceps brachii in movements at the glenohumeral joint. Acta Anat. 1976;96(2):270–84.
Neviaser TJ, Neviaser RJ, Neviaser JS, Neviaser JS. The four-in-one arthroplasty for the painful arc syndrome. Clin Orthop Relat Res. 1982;163(163):107–12.
Jobe F, Moynes D, Tibone J, Perry J. An EMG analysis of the shoulder in pitching. Am J Sports Med. 1984;12(3):218–20.
Petersson CJ. Spontaneous medial dislocation of the tendon of the long biceps brachii. An anatomic study of prevalence and pathomechanics.Clinical orthopaedics and related research. 1986(211):224–7.
Glousman R, Jobe F, Tibone J, Moynes D, Antonelli D, Perry J. Dynamic electromyographic analysis of the throwing shoulder with glenohumeral instability. J bone joint Surg Am volume. 1988;70(2):220–6.
Mariani EM, Cofield RH, Askew LJ, Li G, Chao EYS. Rupture of the tendon of the long head of the biceps brachii. Surgical versus nonsurgical treatment. Clin Orthop Relat Res. 1988;228(228):233–9.
Kumar VP, Satku K, Balasubramaniam P. The role of the long head of biceps brachii in the stabilization of the head of the humerus.Clin Orthop Relat Res. 1989(244):172–5.
Kosugi K, Shibata S, Yamashita H. Supernumerary head of biceps brachii and branching pattern of the musculocutaneus nerve in japanese. Surg Radiol Anat. 1992;14(2):175–85.
Brown JM, Solomon C, Paton M. Further evidence of functional differentiation within biceps brachii. Electromyogr Clin Neurophysiol. 1993;33(5):301–9.
Itoi E, Kuechle DK, Newman SR, Morrey BF, An KN. Stabilising function of the biceps in stable and unstable shoulders. J Bone Joint Surg Br. 1993;75(4):546–50.
Itoi E, Newman SR, Kuechle DK, Morrey BF, An KN. Dynamic anterior stabilisers of the shoulder with the arm in abduction. J bone joint Surg Br volume. 1994;76(5):834–6.
Rodosky MW, Harner CD, Fu FH. The role of the long head of the biceps muscle and superior glenoid labrum in anterior stability of the shoulder. Am J Sports Med. 1994;22(1):121–30.
Vangsness CT Jr, Jorgenson SS, Watson T, Johnson DL. The origin of the long head of the biceps from the scapula and glenoid labrum. An anatomical study of 100 shoulders. J Bone Joint Surg - Ser B. 1994;76(6):951–4.
Williams MM, Snyder SJ, Buford D. Jr. The Buford complex–the “cord-like” middle glenohumeral ligament and absent anterosuperior labrum complex: a normal anatomic capsulolabral variant. Arthroscopy: the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 1994;10(3):241–7.
Pagnani MJ, Deng XH, Warren RF, Torzilli PA, Altchek DW. Effect of lesions of the superior portion of the glenoid labrum on glenohumeral translation. J bone joint Surg Am volume. 1995;77(7):1003–10.
Refior HJ, Sowa D. Long tendon of the biceps brachii: Sites of predilection for degenerative lesions. J Shoulder Elbow Surg. 1995;4(6):436–40.
Warner JJP, McMahon PJ. The role of the long head of the biceps brachii in superior stability of the glenohumeral joint. J Bone Joint Surg - Ser A. 1995;77(3):366–72.
Pagnani MJ, Deng XH, Warren RF, Torzilli PA, O’Brien SJ. Role of the long head of the biceps brachii in glenohumeral stability: a biomechanical study in cadavera. J Shoulder Elbow Surg. 1996;5(4):255–62.
Mariani PP, Bellelli A, Botticella C. Arthroscopic absence of the long head of the biceps tendon. Arthroscopy: the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 1997;13(4):499–501.
Yamaguchi K, Riew KD, Galatz LM, Syme JA, Neviaser RJ, Yamaguchi K, et al. Biceps activity during shoulder motion: an electromyographic analysis. Clin Orthop Relat Res. 1997;336:122–9.
Bennett WF. Specificity of the speed’s test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy. 1998;14(8):789–96.
Kido T, Itoi E, Konno N, Sano A, Urayama M, Sato K. Electromyographic activities of the biceps during arm elevation in shoulders with rotator cuff tears. Acta Orthop Scand. 1998;69(6):575–9.
Read JW, Perko M. Shoulder ultrasound: diagnostic accuracy for impingement syndrome, rotator cuff tear, and biceps tendon pathology. J Shoulder Elbow Surg. 1998;7(3):264–71.
Sakurai G, Ozaki J, Tomita Y, Nishimoto K, Tamai S. Electromyographic analysis of shoulder joint function of the biceps brachii muscle during isometric contraction.Clinical Orthopaedics and Related Research. 1998(354):123–31.
Walch G, Nové-Josserand L, Boileau P, Levigne C. Subluxations and dislocations of the tendon of the long head of the biceps. J Shoulder Elbow Surg. 1998;7(2):100–8.
David G, Magarey ME, Jones MA, Dvir Z, Türker KS, Sharpe M. EMG and strength correlates of selected shoulder muscles during rotations of the glenohumeral joint. Clin Biomech (Bristol Avon). 2000;15(2):95–102.
Kido T, Itoi E, Konno N, Sano A, Urayama M, Sato K. The depressor function of biceps on the head of the humerus in shoulders with tears of the rotator cuff. J Bone Joint Surgery-British Volume. 2000;82B(3):416–9.
Murthi AM, Vosburgh CL, Neviaser TJ. The incidence of pathologic changes of the long head of the biceps tendon. J Shoulder Elbow Surg. 2000;9(5):382–5.
Teefey SA, Hasan SA, Middleton WD, Patel M, Wright RW, Yamaguchi K. Ultrasonography of the rotator cuff. A comparison of ultrasonographic and arthroscopic findings in one hundred consecutive cases. J Bone Joint Surg Am. 2000;82(4):498–504.
Halder AM, Zhao KD, O’Driscoll SW, Morrey BF, An KN. Dynamic contributions to superior shoulder stability. J Orthop Res. 2001;19(2):206–12.
Kim SH, Ha KI, Kim HS, Kim SW. Electromyographic activity of the biceps brachii muscle in shoulders with anterior instability. Arthroscopy-the J Arthroscopic Relat Surg. 2001;17(8):864–8.
Levy AS, Kelly BT, Lintner SA, Osbahr DC, Speer KP. Function of the long head of the biceps at the shoulder: electromyographic analysis. J Shoulder Elbow Surg. 2001;10(3):250–5.
Ilahi OA, Labbe MR, Cosculluela P. Variants of the anterosuperior glenoid labrum and associated pathology. Arthroscopy: The Journal of Arthroscopic and Related Surgery. 2002;18(8):882–6.
Smith EL, Matzkin EG, Kim DH, Harpstrite JK, Kan DM. Congenital absence of the long head of the biceps brachii tendon as a VATER association. Am J Orthop (Belle Mead NJ). 2002;31(8):452–4.
Beall DP, Williamson EE, Ly JQ, Adkins MC, Emery RL, Jones TP, et al. Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff. AJR Am J Roentgenol. 2003;180(3):633–9.
Glueck DA, Mair SD, Johnson DL. Shoulder instability with absence of the long head of the biceps tendon. Arthroscopy: the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2003;19(7):787–9.
Rao AG, Kim TK, Chronopoulos E, McFarland EG. Anatomical variants in the Anterosuperior aspect of the Glenoid Labrum. J Bone Joint Surg Am Volume. 2003;85(4):653.
Enad JG. Bifurcate origin of the long head of the biceps tendon. Arthroscopy. 2004;20(10):1081–3.
Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S. Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elbow Surg. 2004;13(1):5–12.
Mohtadi NG, Vellet AD, Clark ML, Hollinshead RM, Sasyniuk TM, Fick GH, et al. A prospective, double-blind comparison of magnetic resonance imaging and arthroscopy in the evaluation of patients presenting with shoulder pain. J Shoulder Elbow Surg. 2004;13(3):258–65.
Chen CH, Hsu KY, Chen WJ, Shih CH. Incidence and severity of biceps long head tendon lesion in patients with complete rotator cuff tears. J Trauma. 2005;58(6):1189–93.
Deutch SR, Gelineck J, Johannsen HV, Sneppen O. Permanent disabilities in the displaced muscle from rupture of the long head tendon of the biceps. Scand J Med Sci Sports. 2005;15(3):159–62.
Franco JC, Knapp TP, Mandelbaum BR, Franco JC, Knapp TP, Mandelbaum BR. Congenital absence of the long head of the biceps tendon. A case report. Journal of Bone & Joint Surgery, American Volume. 2005;87(7):1584-6.
Toshiaki A, Itoi E, Minagawa H, Yamamoto N, Tuoheti Y, Seki N, et al. Cross-sectional area of the tendon and the muscle of the biceps brachii in shoulders with rotator cuff tears: a study of 14 cadaveric shoulders. Acta Orthop. 2005;76(4):509–12.
Walch G, Edwards TB, Boulahia A, Nove-Josserand L, Neyton L, Szabo I. Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: Clinical and radiographic results of 307 cases. 2005. p.238–46.
Ardic F, Kahraman Y, Kacar M, Kahraman MC, Findikoglu G, Yorgancioglu ZR. Shoulder impingement syndrome: relationships between clinical, functional, and radiologic findings. Am J Phys Med Rehabil. 2006;85(1):53–60.
Armstrong A, Teefey SA, Wu T, Clark AM, Middleton WD, Yamaguchi K, 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.
Gleason PD, Beall DP, Sanders TG, Bond JL, Ly JQ, Holland LL, et al. The transverse humeral ligament: a separate anatomical structure or a continuation of the osseous attachment of the rotator cuff? Am J Sports Med. 2006;34(1):72–7.
Schoenleber SJ, Spinner RJ. An unusual variant of the biceps brachii. Clin Anat. 2006;19(8):702–3.
Swaringen JC, Mell AG, Langenderfer J, LaScalza S, Hughes RE, Kuhn JE. Electromyographic analysis of physical examination tests for type II superior labrum anterior-posterior lesions. J Shoulder Elbow Surg. 2006;15(5):576–9.
Boileau P, Baqué F, Valerio L, Ahrens P, Chuinard C, Trojani C. Isolated arthroscopic biceps tenotomy or Tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J bone joint Surg Am volume. 2007;89(4):747–57.
Castagna A, Mouhsine E, Conti M, Vinci E, Borroni M, Giardella A, et al. Chondral print on humeral head: an indirect sign of long head biceps tendon instability. Knee Surg Sports Traumatol Arthrosc. 2007;15(5):645–8.
Gill HS, El Rassi G, Bahk MS, Castillo RC, McFarland EG. Physical examination for partial tears of the biceps tendon. Am J Sports Med. 2007;35(8):1334–40.
Kim KC, Rhee KJ, Shin HD, Kim YM. Biceps long head tendon revisited: a case report of split tendon arising from single origin. Arch Orthop Trauma Surg. 2007;128(5):495–8.
Lafosse LMD, Reiland YMD, Baier GPMD, Toussaint BMD, Jost BMD. Anterior and posterior instability of the long head of the Biceps Tendon in Rotator Cuff tears: a new classification based on arthroscopic observations. Arthroscopy. 2007;23(1):73–80.
MacDonald K, Bridger J, Cash C, Parkin I. Transverse humeral ligament: does it exist? Clin Anat. 2007;20(6):663–7.
Ilahi OA, Cosculluela PE, Ho DM. Classification of anterosuperior glenoid labrum variants and their association with shoulder pathology. Orthopedics. 2008;31(3):226.
Landin D, Myers J, Thompson M, Castle R, Porter J. The role of the biceps brachii in shoulder elevation. J Electromyogr Kinesiol. 2008;18(2):270–5.
Sayeed SA, Shah JP, Collins MS, Dahm DL. Absence of the long head of the biceps tendon associated with glenoid dysplasia and posterior labral tear. Clin Anat. 2008;21(7):728–32.
Vijayabhaskar P, Baral P, Vaishya R, Shrestha RN. Supernumerary head of biceps brachii: a rare occurrence in the nepalese population. Kathmandu Univ Med J (KUMJ). 2008;6(2):225–7.
Ben Kibler W, Sciascia AD, Hester P, Dome D, Jacobs C. Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Am J Sports Med. 2009;37(9):1840–7.
Koplas MC, Winalski CS, Ulmer WH Jr, Recht M. Bilateral congenital absence of the long head of the biceps tendon. Skeletal Radiol. 2009;38(7):715–9.
Oliveira LF, Matta TT, Alves DS, Garcia MAC, Vieira TMM. Effect of the shoulder position on the biceps brachii EMG in different dumbbell curls. J Sports Sci Med. 2009;8(1):24–9.
Rojas IL, Provencher MT, Bhatia S, Foucher KC, Bach BR Jr, Romeo AA, et al. Biceps activity during windmill softball pitching: injury implications and comparison with overhand throwing. Am J Sports Med. 2009;37(3):558–65.
Youm T, ElAttrache NS, Tibone JE, McGarry MH, Lee TQ. The effect of the long head of the biceps on glenohumeral kinematics. J Shoulder Elbow Surg. 2009;18(1):122–9.
Gheno R, Zoner CS, Buck FM, Nico MAC, Haghighi P, Trudell DJ, et al. Accessory head of biceps brachii muscle: anatomy, histology, and MRI in cadavers. Am J Roentgenol. 2010;194(1):W80–W3.
Lakemeier S, Reichelt JJ, Timmesfeld N, Fuchs-Winkelmann S, Paletta JR, Schofer MD. The relevance of long head biceps degeneration in the presence of rotator cuff tears. BMC Musculoskelet Disord. 2010;11:191.
Su WR, Budoff JE, Luo ZP, Su W-R, Budoff JE, Luo Z-P. The effect of posterosuperior rotator cuff tears and biceps loading on glenohumeral translation. Arthroscopy: The Journal of Arthroscopy & Related Surgery. 2010;26(5):578–86.
Braun S, Horan MP, Elser F, Millett PJ. Lesions of the biceps pulley. Am J Sports Med. 2011;39(4):790–5.
De Maeseneer M, Boulet C, Pouliart N, Kichouh M, Buls N, Verhelle F, et al. Assessment of the long head of the biceps tendon of the shoulder with 3T magnetic resonance arthrography and CT arthrography. Eur J Radiol. 2011;81(5):934–9.
Hashiuchi T, Sakurai G, Morimoto M, Komei T, Takakura Y, Tanaka Y. Accuracy of the biceps tendon sheath injection: ultrasound-guided or unguided injection? A randomized controlled trial. J Shoulder Elbow Surg. 2011;20(7):1069–73.
Lim TK, Moon ES, Koh KH, Yoo JC. Patient-related factors and complications after arthroscopic tenotomy of the long head of the biceps tendon. Am J Sports Med. 2011;39(4):783–9.
Mitra R, Nguyen A, Stevens KJ. Fluoroscopically guided supraglenoid tubercle steroid injections for the management of biceps tendonitis. Pain Pract. 2011;11(4):392–6.
Patzer T, Habermeyer P, Hurschler C, Bobrowitsch E, Paletta JR, Fuchs-Winkelmann S, et al. Increased glenohumeral translation and biceps load after SLAP lesions with potential influence on glenohumeral chondral lesions: a biomechanical study on human cadavers. Knee Surg Sports Traumatol Arthrosc. 2011;19(10):1780–7.
Skendzel JG, Jacobson JA, Carpenter JE, Miller BS. Long head of biceps brachii tendon evaluation: accuracy of preoperative ultrasound. AJR Am J Roentgenol. 2011;197(4):942–8.
Uzel AP, Bertino R, Boileau P. Bilateral spontaneous tenodesis of the long head of the biceps at the bicipital groove with massive rotator cuff tear on a 103-year-old female cadaver: the natural evolution of the human shoulder? Musculoskelet Surg. 2011;95(S1):79–82.
Zhang J, Ebraheim N, Lause GE. Ultrasound-guided injection for the biceps brachii tendinitis: results and experience. Ultrasound Med Biol. 2011;37(5):729–33.
Chen CH, Chen CH, Chang CH, Su CI, Wang KC, Wang IC, et al. Classification and analysis of pathology of the long head of the biceps tendon in complete rotator cuff tears. Chang Gung Med J. 2012;35(3):263–70.
Giphart JE, Elser F, Dewing CB, Torry MR, Millett PJ. The long head of the biceps tendon has minimal effect on in vivo glenohumeral kinematics: a biplane fluoroscopy study. Am J Sports Med. 2012;40(1):202–12.
Hanypsiak B, Nguyen M, McGarry M, Morgan C, Gupta R, Lee TQ. The role of the biceps brachii in overhead throwing: a biomechanical study. Arthrosc - J Arthroscopic Relat Surg. 2012;28(6):e4.
Hawkes DH, Alizadehkhaiyat O, Fisher AC, Kemp GJ, Roebuck MM, Frostick SP. Normal shoulder muscular activation and co-ordination during a shoulder elevation task based on activities of daily living: an electromyographic study. J Orthop Res. 2012;30(1):53–60.
Hawkes DH, Alizadehkhaiyat O, Kemp GJ, Fisher AC, Roebuck MM, Frostick SP. Shoulder muscle activation and coordination in patients with a massive rotator cuff tear: an electromyographic study. J Orthop Res. 2012;30(7):1140–6.
Nejat N, Mathieu PA, Bertrand M. Investigation on muscle compartments in the Biceps Brachii. J Med Biol Eng. 2012;32(4):251–7.
Schaeffeler C, Waldt S, Holzapfel K, Kirchhoff C, Jungmann PM, Wolf P, et al. Lesions of the biceps pulley: diagnostic accuracy of MR arthrography of the shoulder and evaluation of previously described and new diagnostic signs. Radiology. 2012;264(2):504–13.
Wittstein JMD, Lassiter TMD, Taylor DMD. Aberrant origin of the long head of the biceps: a case series. J Shoulder Elbow Surg. 2012;21(3):356–60.
Alexander S, Southgate DF, Bull AM, Wallace AL. The role of negative intraarticular pressure and the long head of biceps tendon on passive stability of the glenohumeral joint. J Shoulder Elbow Surg. 2013;22(1):94–101.
Biederwolf NE. A proposed evidence-based shoulder special testing examination algorithm: clinical utility based on a systematic review of the literature. Int J Sports Phys Ther. 2013;8(4):427–40.
Genovese E, Spanò E, Castagna A, Leonardi A, Angeretti MG, Callegari L, et al. MR-arthrography in superior instability of the shoulder: correlation with arthroscopy. Radiologia Med. 2013;118(6):1022–33.
Gillardin P, Vanhoenacker FM, Wauters T, De Backer AI. Congenital absence of long head of the biceps tendon. J Belg Soc Radiol. 2013;96(5):320.
Huang S-W, Wang W-T. Quantitative diagnostic method for Biceps Long Head Tendinitis by using Ultrasound. TheScientificWorld. 2013;2013:948323–7.
Mazzocca AD, McCarthy MB, Ledgard FA, Chowaniec DM, McKinnon WJ Jr, Delaronde S, et al. Histomorphologic changes of the long head of the biceps tendon in common shoulder pathologies. Arthroscopy. 2013;29(6):972–81.
Moon J, Shin I, Kang M, Kim Y, Lee K, Park J, et al. The effect of shoulder flexion angles on the recruitment of Upper-extremity muscles during isometric contraction. J Phys Ther Sci. 2013;25(10):1299–301.
Nasr AY, Hussein AM. Morphology and clinical implication of the extra-head of biceps brachii muscle. Folia Morphol (Warsz). 2013;72(4):349–56.
Ahamed NU, Sundaraj K, Ahmad B, Rahman M, Ali MA, Islam MA. Surface electromyographic analysis of the biceps brachii muscle of cricket bowlers during bowling. Australas Phys Eng Sci Med. 2014;37(1):83–95.
Arrigoni P, Ragone V, D’Ambrosi R, Denard P, Randelli F, Banfi G, et al. Improving the accuracy of the preoperative diagnosis of long head of the biceps pathology: the biceps resisted flexion test. Joints. 2014;2(2):54–8.
Chalmers PN, Cip J, Trombley R, Cole BJ, Wimmer MA, Romeo AA, et al. Glenohumeral function of the long head of the Biceps muscle: an Electromyographic Analysis. Orthop J Sports Med. 2014;2(2):2325967114523902.
Cools AM, Borms D, Cottens S, Himpe M, Meersdom S, Cagnie B. Rehabilitation exercises for athletes with Biceps Disorders and SLAP Lesions: a continuum of exercises with increasing loads on the biceps. Am J Sports Med. 2014;42(6):1315–22.
Dubrow SA, Streit JJ, Shishani Y, Robbin MR, Gobezie R. Diagnostic accuracy in detecting tears in the proximal biceps tendon using standard nonenhancing shoulder MRI. Open Access J Sports Med. 2014;5:81–7.
Festa A, Allert J, Issa K, Tasto JP, Myer JJ. Visualization of the extra-articular portion of the long head of the biceps tendon during intra-articular shoulder arthroscopy. Arthroscopy. 2014;30(11):1413–7.
Hawkes DH, Alizadehkhaiyat O, Kemp GJ, Fisher AC, Roebuck MM, Frostick SP. Electromyographic assessment of muscle fatigue in massive rotator cuff tear. J Electromyogr Kinesiol. 2014;25(1):93–9.
Lisowski JK, Oyama S, Hibberd EE, Myers JB, Prentice WE, Creighton RA. Biceps Brachii does not play an active role in Humeral Movement. Athletic Train Sports Health Care: J Practicing Clinician. 2014;6(4):179–88.
Nourissat G, Tribot-Laspiere Q, Aim F, Radier C. Contribution of MRI and CT arthrography to the diagnosis of intra-articular tendinopathy of the long head of the biceps. Orthop Traumatol Surg Res. 2014;100(8 Suppl):391–4.
Pandey V, van Laarhoven SN, Arora G, Rao S. Bifurcated intraarticular long head of biceps tendon. Indian J Orthop. 2014;48(4):432–4.
Redondo-Alonso L, Chamorro-Moriana G, Jiménez-Rejano JJ, López-Tarrida P, Ridao-Fernández C. Relationship between chronic pathologies of the supraspinatus tendon and the long head of the biceps tendon: systematic review. BMC Musculoskelet Disord. 2014;15:377.
Zhang AL, Gates CH, Link TM, Ma CB. Abnormal origins of the long head of the biceps tendon can lead to rotator cuff pathology: a report of two cases. Skeletal Radiol. 2014;43(11):1621–6.
Aly A-R, Rajasekaran S, Ashworth N. Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med. 2015;49(16):1042–9.
Banerjee S, Patel VR. Anomalous biceps origin from the rotator cuff. Indian J Orthop. 2015;49(1):105–8.
Fischer CA, Weber M-A, Neubecker C, Bruckner T, Tanner M, Zeifang F. Ultrasound vs. MRI in the assessment of rotator cuff structure prior to shoulder arthroplasty. J Orthop. 2015;12(1):23–30.
Fraser PR, Howard LW, Rosales AA, Guttmann GD. Bilateral symmetrical supernumerary heads of biceps brachii with rare pectoralis major insertion. Surg Radiol Anat. 2015;37(3):299–302.
Fyhr C, Gustavsson L, Wassinger C, Sole G. The effects of shoulder injury on kinaesthesia: a systematic review and meta-analysis. Man Therap. 2015;20(1):28–37.
Ge H, Zhang Q, Sun Y, Li J, Sun L, Cheng B. Tenotomy or tenodesis for the long head of biceps lesions in shoulders: a systematic review and meta-analysis. PLoS ONE. 2015;10(3):e0121286.
Gilmer BB, DeMers AM, Guerrero D, Reid JB 3rd, Lubowitz JH, Guttmann D. Arthroscopic versus open comparison of long head of biceps tendon visualization and pathology in patients requiring tenodesis. Arthroscopy. 2015;31(1):29–34.
Leroux T, Chahal J, Wasserstein D, Verma NN, Romeo AA. A systematic review and Meta-analysis comparing clinical outcomes after concurrent Rotator Cuff Repair and Long Head Biceps Tenodesis or Tenotomy. Sports Health. 2015;7(4):303–7.
Malavolta EA, Assunção JH, Guglielmetti CLB, de Souza FF, Gracitelli MEC, Ferreira Neto AA. Accuracy of preoperative MRI in the diagnosis of disorders of the long head of the biceps tendon. Eur J Radiol. 2015;84(11):2250–4.
Moon SC, Cho NS, Rhee YG. Analysis of “hidden lesions” of the extra-articular biceps after subpectoral biceps tenodesis: the subpectoral portion as the optimal tenodesis site. Am J Sports Med. 2015;43(1):63–8.
Petscavage-Thomas J, Gustas C. Comparison of ultrasound-guided to fluoroscopy-guided biceps tendon sheath injection. Ultrasound Med Biol. 2015;41(4):89.
Shi LL, Mullen MG, Freehill MT, Lin A, Warner JJ, Higgins LD. Accuracy of long head of the biceps subluxation as a predictor for subscapularis tears. Arthroscopy. 2015;31(4):615–9.
Singh R, Singla M, Tubbs RS. Macro/micro observational studies of fibres maintaining the biceps brachii tendon in the bicipital groove: application to surgery, pathology and kinesiology. Folia Morphol (Warsz). 2015;74(4):439–46.
Tadros AS, Huang BK, Wymore L, Hoenecke H, Fronek J, Chang EY. Long head of the biceps brachii tendon: unenhanced MRI versus direct MR arthrography. Skeletal Radiol. 2015;44(9):1263–72.
Taylor SAMD, Khair MMMD, Gulotta LVMD, Pearle ADMD, Baret NJ, Newman AMBS, et al. Diagnostic glenohumeral arthroscopy fails to fully evaluate the Biceps-Labral Complex. Arthroscopy. 2015;31(2):215–24.
Yershov D, Hudák R. Unusual variation of the Biceps Brachii with possible median nerve entrapment. Prague Med Rep. 2015;116(2):167–72.
Zhang Q, Zhou J, Ge H, Cheng B. Tenotomy or tenodesis for long head biceps lesions in shoulders with reparable rotator cuff tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc. 2015;23(2):464–9.
Abraham VT, Tan BH, Kumar VP. Systematic review of Biceps Tenodesis: arthroscopic Versus Open. Arthroscopy. 2016;32(2):365–71.
Banerjee M, Müller-Hübenthal J, Grimme S, Balke M, Bouillon B, Lefering R et al. Moderate value of non-contrast magnetic resonance imaging after non-dislocating shoulder trauma. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA. 2016;24(6):1888–95.
Creech MJ, Yeung M, Denkers M, Simunovic N, Athwal GS, Ayeni OR. Surgical indications for long head biceps tenodesis: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2016;24(7):2156–66.
Duchman KR, DeMik DE, Uribe B, Wolf BR, Bollier M. Open Versus arthroscopic biceps tenodesis: a comparison of functional outcomes. Iowa Orthop J. 2016;36:79–87.
Gurnani N, van Deurzen DF, Janmaat VT, van den Bekerom MP. Tenotomy or tenodesis for pathology of the long head of the biceps brachii: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2016;24(12):3765–71.
Hanusch BC, Makaram N, Utrillas-Compaired A, Lawson-Smith MJ, Rangan A. Biceps sheath fluid on shoulder ultrasound as a predictor of rotator cuff tear: analysis of a consecutive cohort. J Shoulder Elbow Surg. 2016;25(10):1661–7.
Kerschbaum M, Arndt L, Bartsch M, Chen J, Gerhardt C, Scheibel M. Using the LHB score for assessment of LHB pathologies and LHB surgery: a prospective study. Arch Orthop Trauma Surg. 2016;136(4):469–75.
Lee R, Choi S-J, Lee M, Ahn J, Shin D, Kang C, et al. Diagnostic accuracy of 3T conventional shoulder MRI in the detection of the long head of the biceps tendon tears associated with rotator cuff tendon tears. Skeletal Radiol. 2016;45(12):1705–15.
Lewis JS, McCreesh K, Barratt E, Hegedus EJ, Sim J. Inter-rater reliability of the shoulder Symptom Modification Procedure in people with shoulder pain. BMJ Open Sport Exerc Med. 2016;2(1):e000181.
Malavolta EA, Assunção JH, Guglielmetti CL, de Souza FF, Gracitelli ME, Bordalo-Rodrigues M, et al. Accuracy of preoperative MRI in the diagnosis of subscapularis tears. Arch Orthop Trauma Surg. 2016;136(10):1425–30.
McGarry MH, Nguyen ML, Quigley RJ, Hanypsiak B, Gupta R, Lee TQ. The effect of long and short head biceps loading on glenohumeral joint rotational range of motion and humeral head position. KNEE Surg SPORTS Traumatol Arthrosc. 2016;24(6):1979–87.
Meraner D, Sternberg C, Vega J, Hahne J, Kleine M, Leuzinger J. Arthroscopic tenodesis versus tenotomy of the long head of biceps tendon in simultaneous rotator cuff repair. Arch Orthop Trauma Surg. 2016;136(1):101–6.
Razmjou H, Fournier-Gosselin S, Christakis M, Pennings A, ElMaraghy A, Holtby R. Accuracy of magnetic resonance imaging in detecting biceps pathology in patients with rotator cuff disorders: comparison with arthroscopy. J Shoulder Elbow Surg. 2016;25(1):38–44.
Sahu D, Fullick R, Giannakos A, Lafosse L. Sentinel sign: a sign of biceps tendon which indicates the presence of subscapularis tendon rupture. Knee Surg Sports Traumatol Arthrosc. 2016;24(12):3745–9.
Shah SH, Small KM, Sinz NJ, Higgins LD. Morphology of the lesser tuberosity and intertubercular groove in patients with arthroscopically confirmed Subscapularis and Biceps Tendon Pathology. Arthroscopy: The Journal of Arthroscopy & Related Surgery. 2016;32(6):968–75.
Urita A, Funakoshi T, Amano T, Matsui Y, Kawamura D, Kameda Y, et al. Predictive factors of long head of the biceps tendon disorders-the bicipital groove morphology and subscapularis tendon tear. J Shoulder Elbow Surg. 2016;25(3):384–9.
Borms D, Ackerman I, Smets P, Van den Berge G, Cools AM. Biceps Disorder Rehabilitation for the Athlete. Am J Sports Med. 2017;45(3):642–50.
Grassbaugh JA, Bean BR, Greenhouse AR, Yu HH, Arrington ED, Friedman RJ, et al. Refuting the lipstick sign. J Shoulder Elbow Surg. 2017;26(8):1416–22.
Hawi N, Liodakis E, Garving C, Habermeyer P, Tauber M. Pulley lesions in rotator cuff tears: prevalence, etiology, and concomitant pathologies. Arch Orthop Trauma Surg. 2017;137(8):1097–105.
Huguet D, Darrieutort-Laffite C, Le Goff B. Comparison of ultrasound and MRI in the diagnosis of proximal and distal biceps tendon pathology. Ann Rheum Dis. 2017;76:731.
Jeung Yeol J, Seung Min P, Young Eun P, Jae Chul Y, Jeong JY, Park SM, et al. Morphological classification of anatomical variants of the intra-articular portion of the long head of the biceps brachii tendon and analysis of the incidence and the relationship with shoulder disease for each subtype. J Orthop Surg (10225536). 2017;25(3):1–6.
Jordan RW, Saithna A. Physical examination tests and imaging studies based on arthroscopic assessment of the long head of biceps tendon are invalid. Knee Surg Sports Traumatol Arthrosc. 2017;25(10):3229–36.
Kang Y, Lee JW, Ahn JM, Lee E, Kang HS. Instability of the long head of the biceps tendon in patients with rotator cuff tear: evaluation on magnetic resonance arthrography of the shoulder with arthroscopic correlation. Skeletal Radiol. 2017;46(10):1335–42.
Khil EK, Cha JG, Yi JS, Kim H-J, Min KD, Yoon YC, et al. Detour sign in the diagnosis of subluxation of the long head of the biceps tendon with arthroscopic correlation. Br J Radiol. 2017;90(1070):20160375.
Kumar CD, Rakesh J, Tungish B, Singh DM. Congenital absence of the long head of biceps tendon & its clinical implications: a systematic review of the literature. Muscles Ligaments & Tendons Journal (MLTJ). 2017;7(3):562–9.
Nascimento AT, Claudio GK. Magnetic resonance imaging without contrast as a diagnostic method for partial injury of the long head of the biceps tendon. Rev Bras Ortop. 2017;52(1):40–5.
Rosas S, Krill MK, Amoo-Achampong K, Kwon K, Nwachukwu BU, McCormick F. A practical, evidence-based, comprehensive (PEC) physical examination for diagnosing pathology of the long head of the biceps. J Shoulder Elbow Surg. 2017;26(8):1484–92.
Shang X, Chen J, Chen S. A meta-analysis comparing tenotomy and tenodesis for treating rotator cuff tears combined with long head of the biceps tendon lesions. PLoS ONE. 2017;12(10):e0185788.
Winston BA, Robinson K, Crawford D. Monocept”: a brief report of congenital absence of the long head of the Biceps Tendon and Literature Review. Case Rep Orthop. 2017;2017:1090245.
Zabrzyński J, Paczesny Ł, Łapaj Ł, Grzanka D, Szukalski J. Is the inflammation process absolutely absent in tendinopathy of the long head of the biceps tendon? Histopathologic study of the long head of the biceps tendon after arthroscopic treatment. Pol J Pathol. 2017;68(4):318–25.
Cutler HS, Tao MA, O’Brien SJ, Taylor SA. Trifurcate Origin of Long Head of Biceps Brachii: a Case Report and Literature Review. J Orthop Case Rep. 2018;8(4):70–3.
Godenèche A, Kempf JF, Nové-Josserand L, Michelet A, Saffarini M, Hannink G, et al. Tenodesis renders better results than tenotomy in repairs of isolated supraspinatus tears with pathologic biceps. J Shoulder Elbow Surg. 2018;27(11):1939–45.
Meakins A, May S, Littlewood C. Reliability of the shoulder Symptom Modification Procedure and association of within-session and between-session changes with functional outcomes. BMJ Open Sport Exerc Med. 2018;4(1):e000342.
Motley GS, Guengerich B, Schuller T, Turbyfill A. The Ramp Test: an arthroscopic technique for confirming intra-articular subluxation and instability of the long head of the Biceps Tendon within the shoulder. Arthrosc Tech. 2018;7(4):e327–e30.
Vestermark GL, Van Doren BA, Connor PM, Fleischli JE, Piasecki DP, Hamid N. The prevalence of rotator cuff pathology in the setting of acute proximal biceps tendon rupture. J Shoulder Elbow Surg. 2018;27(7):1258–62.
Yoon JS, Kim SJ, Choi YR, Lee W, Kim SH, Chun YM. Medial subluxation or dislocation of the biceps on magnetic resonance arthrography is reliably correlated with concurrent Subscapularis full-thickness tears confirmed arthroscopically. Biomed Res Int. 2018;2018:2674061.
Zabrzyński J, Paczesny Ł, Łapaj Ł, Grzanka D, Szukalski J, Zabrzyński J, et al. Process of neovascularisation compared with pain intensity in tendinopathy of the long head of the biceps brachii tendon associated with concomitant shoulder disorders, after arthroscopic treatment. Microscopic evaluation supported by immunohistochemical markers of the endothelial cells. Folia Morphol. 2018;77(2):378–85.
Baptista E, Malavolta EA, Gracitelli MEC, Alvarenga D, Bordalo-Rodrigues M, Ferreira Neto AA, et al. Diagnostic accuracy of MRI for detection of tears and instability of proximal long head of biceps tendon: an evaluation of 100 shoulders compared with arthroscopy. Skeletal Radiol. 2019;48(11):1723–33.
Bélanger V, Dupuis F, Leblond J, Roy JS. Accuracy of examination of the long head of the biceps tendon in the clinical setting: a systematic review. J Rehabil Med. 2019;51(7):479–91.
Belay ES, Wittstein JR, Garrigues GE, Lassiter TE, Scribani M, Goldner RD, et al. Biceps tenotomy has earlier pain relief compared to biceps tenodesis: a randomized prospective study. Knee Surg Sports Traumatol Arthrosc. 2019;27(12):4032–7.
Cardoso A, Amaro P, Barbosa L, Coelho AM, Alonso R, Pires L. Diagnostic accuracy of clinical tests directed to the long head of biceps tendon in a surgical population: a combination of old and new tests. J Shoulder Elbow Surg. 2019;28(12):2272–8.
Carroll MA, Lebron EM, Jensen TE, Cooperman TJ. Chondroepitrochlearis and a supernumerary head of the biceps brachii. Anat Sci Int. 2019;94(4):330–4.
El Abiad JM, Faddoul DG, Baydoun H. Case report: broad insertion of a large subscapularis tendon in association with congenital absence of the long head of the biceps tendon. Skeletal Radiol. 2019;48(1):159–62.
Gofeld M, Hurdle MF, Agur A. Biceps Tendon Sheath Injection: An Anatomical Conundrum. Pain medicine (Malden, Mass). 2019;20(1):138 – 42.
Kim JY, Rhee SM, Rhee YG. Accuracy of MRI in diagnosing intra-articular pathology of the long head of the biceps tendon: results with a large cohort of patients. BMC Musculoskelet Disord. 2019;20(1):270.
Loock E, Michelet A, D’Utruy A, Molinazzi P, Hannink G, Bertiaux S, et al. Magnetic resonance arthrography is insufficiently accurate to diagnose biceps lesions prior to rotator cuff repair. Knee Surg Sports Traumatol Arthrosc. 2019;27(12):3970–8.
Sabzevari S, Khalilipour Roudi M, Kalawadia J, Lin A. Chronic long head biceps Tendinitis secondary to Anomalous Origins in Young Patients: a Case Series. Arch Bone Jt Surg. 2019;7(6):493–7.
Sasaki S, Kenmoku T, Otera A, Miyajima G, Nagura N, Nakawaki M, et al. Electromyographic analysis of infraspinatus and scapular muscles during external shoulder rotation with different weight loads and positions. J Orthop Sci. 2019;24(1):75–80.
Schmalzl J, Plumhoff P, Gilbert F, Gohlke F, Konrads C, Brunner U et al. The inflamed biceps tendon as a pain generator in the shoulder: A histological and biomolecular analysis.Journal of Orthopaedic Surgery. 2019;27(1).
Aflatooni JO, Meeks BD, Froehle AW, Bonner KF. Biceps tenotomy versus tenodesis: patient-reported outcomes and satisfaction. J Orthop Surg Res. 2020;15(1):56.
Ager AL, Borms D, Deschepper L, Dhooghe R, Dijkhuis J, Roy J-S, et al. Proprioception: how is it affected by shoulder pain? A systematic review. J Hand Ther. 2020;33(4):507–16.
Anil U, Hurley ET, Kingery MT, Pauzenberger L, Mullett H, Strauss EJ. Surgical treatment for long head of the biceps tendinopathy: a network meta-analysis. J Shoulder Elbow Surg. 2020;29(6):1289–95.
Chae SH, Jung TW, Lee SH, Kim MJ, Park SM, Jung JY, et al. Hidden long head of the Biceps Tendon instability and concealed intratendinous Subscapularis tears. Orthop J Sports Med. 2020;8(1):2325967119898123.
Dirkx G, Pouliart N. How reliable are imaging protocols in the diagnosis of subscapularis tears? Acta Orthop Belg. 2020;86(4):706–10.
Horan M, Dekker T, Goldenberg B, Dornan G, Peebles L, Provencher M et al. Superior labrum anterior-posterior (SLAP) repair versus subpectoral biceps tenodesis for isolated slap II lesions in overhead athletes aged younger 35 years: A comparison of minimum two-year outcomes.Orthopaedic Journal of Sports Medicine. 2020;8(7 SUPPL 6).
Kim BR, Lee J, Ahn JM, Kang Y, Lee E, Lee JW et al. Predicting the clinically significant subscapularis tendon tear: malposition and tear of the long head of the biceps tendon on shoulder magnetic resonance imaging.Acta Radiol. 2020:284185120980017.
Li D, Wang W, Liu Y, Ma X, Huang S, Qu Z. The backward traction test: a new and effective test for diagnosis of biceps and pulley lesions. J Shoulder Elbow Surg. 2020;29(2):e37–e44.
Lim S, Kim SK, Kim YS. Comparison between SLAP repair and biceps tenodesis with concomitant rotator cuff repair in patients older than 45 years: Minimum 2-Year Clinical and Imaging Outcomes. Clin Orthop Surg. 2020;12(3):364–70.
MacDonald P, Verhulst F, McRae S, Old J, Stranges G, Dubberley J, et al. Biceps Tenodesis Versus Tenotomy in the treatment of lesions of the long head of the Biceps Tendon in Patients undergoing arthroscopic shoulder surgery: a prospective double-blinded Randomized Controlled Trial. Am J Sports Med. 2020;48(6):1439–49.
McDevitt AW, Snodgrass SJ, Cleland JA, Leibold MBR, Krause LA, Mintken PE. Treatment of individuals with chronic bicipital tendinopathy using dry needling, eccentric-concentric exercise and stretching; a case series. Physiother Theory Pract. 2020;36(3):397–407.
Mehta SK, Teefey SA, Middleton W, Steger-May K, Sefko JA, Keener JD. Prevalence and risk factors for development of subscapularis and biceps pathology in shoulders with degenerative rotator cuff disease: a prospective cohort evaluation. J Shoulder Elbow Surg. 2020;29(3):451–8.
Mirzayan R, McCrum C, Butler RK, Alluri RK. Risk factors and complications following arthroscopic tenotomy of the long head of the Biceps Tendon. Orthop J Sports Med. 2020;8(2):2325967120904361.
Özer M, Kaptan AY, Ataoglu MB, Cetinkaya M, Ayanoglu T, Ince B et al. The Buford complex: prevalence and relationship with labral pathologies.Journal of Shoulder and Elbow Surgery. 2020.
Riley SP, Grimes JK, Apeldoorn AT, de Vet R. Agreement and reliability of a symptom modification test cluster for patients with subacromial pain syndrome. Physiother Res Int. 2020;25(3):e1842.
Traverso A, Piasecki K, Gallusser N, Farron A. Agenesis of the long head of the biceps brachii tendon: ignored variations of the anatomy and the next tendon to disappear?BMJ Case Rep. 2020;13(5).
van Deurzen DFP, Gurnani N, Alta TDW, Willems JH, Onstenk R, van den Bekerom MPJ. Suprapectoral versus subpectoral tenodesis for long head biceps Brachii tendinopathy: a systematic review and meta-analysis. Orthop Traumatol Surg Res. 2020;106(4):693–700.
Wade R, Shah SS, B SS, Shah KA, Raj A. A rare anatomical variation in the origin of the Tendon of Long Head of Biceps in a 30-Year-old male: a Case Report and Review of Literature. J Orthop Case Rep. 2020;9(6):94–7.
Yiannakopoulos CK, Megaloikonomos PD, Foufa K, Gliatis J. Ultrasound-guided versus palpation-guided corticosteroid injections for tendinosis of the long head of the biceps: a randomized comparative study. Skeletal Radiol. 2020;49(4):585–91.
Ahmed AF, Toubasi A, Mahmoud S, Ahmed GO, Al Ateeq Al Dosari M, Zikria BA. Long head of biceps tenotomy versus tenodesis: a systematic review and meta-analysis of randomized controlled trials. Shoulder & Elbow. 2021;13(6):583–91.
Ayoubi R, Darwish M, Nassour N, Aouad D, Maalouly J, Kanj V, et al. A rare case of an anatomical variation of bilateral long head of the biceps brachii tendons identified within the substance of bifid subscapularis tendons. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2021;23:18–21.
Baek S, Ki SY, Chung SW, Lee SJ, Cho YC, Oh KS. Delayed anticipatory muscle activation in Rotator Cuff Tendinopathy. Orthop J Sports Med. 2021;9(7):23259671211019360.
Beer Y, Gilat R, Ner EB, Shohat N, Atoun E, Lindner D, et al. Impact of body Mass Index on the Accuracy of Physical Examination and MRI of the shoulder. Orthop J Sports Med. 2021;9(2):2325967120985643.
Belk JW, Kraeutler MJ, Houck DA, Chrisman AN, Scillia AJ, McCarty EC. Biceps tenodesis versus tenotomy: a systematic review and meta-analysis of level I randomized controlled trials. J Shoulder Elbow Surg. 2021;30(5):951–60.
Belk JW, Thon SG, Hart J, McCarty EC Jr, McCarty EC. Subpectoral versus suprapectoral biceps tenodesis yields similar clinical outcomes: a systematic review.J isakos. 2021.
Candela V, Preziosi Standoli J, Carbone S, Rionero M, Gumina S. Shoulder long head biceps Tendon Pathology is Associated with increasing Rotator Cuff tear size. Arthrosc Sports Med Rehabil. 2021;3(5):e1517–e23.
DeFroda SF, Li L, Milner J, Bokshan SL, Owens BD. Cost comparison of arthroscopic rotator cuff repair with arthroscopic vs. open biceps tenodesis. J Shoulder Elbow Surg. 2021;30(2):340–5.
Enix D, Scali F, Sudkamp K, Keating R. Supernumerary head of the Biceps Brachii muscle: an anatomic variant with clinical implications. J Chiropr Med. 2021;20(1):37–42.
Eubank BHF, Lackey SW, Slomp M, Werle JR, Kuntze C, Sheps DM. Consensus for a primary care clinical decision-making tool for assessing, diagnosing, and managing shoulder pain in Alberta, Canada. BMC Fam Pract. 2021;22(1):201.
Groarke P, Jagernauth S, Peters SE, Manzanero S, O’Connell P, Cowderoy G et al. Correlation of magnetic resonance and arthroscopy in the diagnosis of shoulder injury.ANZ J Surg. 2021.
Hughes JD, Gibbs CM, Drummond M, Vaswani R, Ayinon C, Fongod E, et al. Failure rates and clinical outcomes after treatment for long-head biceps brachii tendon pathology: a comparison of three treatment types. JSES Int. 2021;5(4):630–5.
Kooistra B, Gurnani N, Weening A, van Deurzen D, van den Bekerom M. Tenotomy or Tenodesis for Tendinopathy of the long head of the Biceps Brachii: an updated systematic review and Meta-analysis. Arthrosc Sports Med Rehabil. 2021;3(4):e1199–e209.
Liu H, Song X, Liu P, Yu H, Zhang Q, Guo W. Clinical outcomes of arthroscopic tenodesis Versus Tenotomy for Long Head of the Biceps Tendon Lesions: a systematic review and Meta-analysis of Randomized clinical trials and Cohort Studies. Orthop J Sports Med. 2021;9(4):2325967121993805.
Patel BH, Agarwalla A, Lu Y, Ouillette RJ, Forsythe B, Amin NH et al. Isolated Biceps Tenodesis and Tenotomy: A Systematic Review of Indications and Patient Satisfaction. Orthopedics. 2021:1–8.
Pozzetti Daou J, Nagaya DY, Matsunaga FT, Sugawara Tamaoki MJ. Does Biceps Tenotomy or Tenodesis have better results after surgery? A systematic review and Meta-analysis. Clin Orthop Relat Res. 2021;479(7):1561–73.
Ulucakoy C, Kaptan AY, Yapar A, Orhan O, Ozer M, Kanatli U. The effect of bicipital groove morphology on the stability of the biceps long head tendon. Arch Orthop Trauma Surg. 2021;141(8):1325–30.
Veen EJD, Koorevaar CT, Verdonschot KHM, Sluijter TE, de Groot T, van der Hoeven JH, et al. Compensatory Movement patterns are based on abnormal activity of the Biceps Brachii and posterior deltoid muscles in patients with symptomatic rotator cuff tears. Clin Orthop Relat Res. 2021;479(2):378–88.
Woodmass JM, McRae SMB, Lapner PL, Sasyniuk T, Old J, Stranges G, et al. Effect of age, gender, and body mass index on incidence and satisfaction of a Popeye deformity following biceps tenotomy or tenodesis: secondary analysis of a randomized clinical trial. J Shoulder Elbow Surg. 2021;30(8):1733–40.
Zhou P, Liu J, Deng X, Li Z. Biceps tenotomy versus tenodesis for lesions of the long head of the biceps tendon: a systematic review and meta-analysis of randomized controlled trials. Med (Baltim). 2021;100(3):e23993.
Zhu XM, Leroux T, Ben-David E, Dennis B, Gohal C, Kirsch JM, et al. A meta-analysis of level I evidence comparing tenotomy vs tenodesis in the management of long head of biceps pathology. J Shoulder Elbow Surg. 2021;30(5):961–8.
Petscavage-Thomas J, Gustas C. Comparison of Ultrasound-Guided to Fluoroscopy-Guided Biceps Tendon Sheath Therapeutic Injection. J Ultrasound Med. 2016;35(10):2217–21.
Morris D, Guettler J, Morris S. Bilateral Superior Labrum anterior to posterior (SLAP) tears with abnormal anatomy of biceps Tendon. Am J Orthop (Belle Mead NJ). 2015;44(8):E275–7.
Kanatli U, Ozturk BY, Bolukbasi S. Anatomical variations of the anterosuperior labrum: prevalence and association with type II superior labrum anterior-posterior (SLAP) lesions. J Shoulder Elbow Surg. 2010;19(8):1199–203.
Nakata W, Katou S, Fujita A, Nakata M, Lefor AT, Sugimoto H. Biceps pulley: normal anatomy and associated lesions at MR arthrography. Radiographics. 2011;31(3):791–810.
Marri K, Swaminathan R. Analysis of concentric and eccentric contractions in biceps brachii muscles using surface electromyography signals and multifractal analysis. Proceedings of the Institution of Mechanical Engineers Part H-Journal of Engineering in Medicine. 2016;230(9):829 – 39.
Knox MF, Chipchase LS, Schabrun SM, Romero RJ, Marshall PWM. Anticipatory and compensatory postural adjustments in people with low back pain: a systematic review and meta-analysis. Spine J. 2018;18(10):1934–49.
Hodges PW, Richardson CA. Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J Spinal Disord. 1998;11(1):46–56.
Massé-Alarie H, Flamand VH, Moffet H, Schneider C. Corticomotor control of deep abdominal muscles in chronic low back pain and anticipatory postural adjustments. Exp Brain Res. 2012;218(1):99–109.
Khandare S, Arce RA, Vidt ME. Muscle compensation strategies to maintain glenohumeral joint stability with increased rotator cuff tear severity: A simulation study.Journal of Electromyography and Kinesiology. 2019.
Kaar SG. CORR Insights®: Compensatory Movement patterns are based on abnormal activity of the Biceps Brachii and posterior deltoid muscles in patients with symptomatic rotator cuff tears. Clin Orthop Relat Research®. 2021;479(2):389–91.
Eakin CL, Faber KJ, Hawkins RJ, Hovis WD. Biceps tendon disorders in athletes. J Am Acad Orthop Surg. 1999;7(5):300–10.
Gerber C, Sebesta A. Impingement of the deep surface of the subscapularis tendon and the reflection pulley on the anterosuperior glenoid rim: a preliminary report. J Shoulder Elbow Surg. 2000;9(6):483–90.
Odonoghue DH, SUBLUXING BICEPS TENDON IN, THE ATHLETE.Clinical Orthopaedics and Related Research. 1982(164):26–9.
Deurzen DFP, Garssen FL, Kerkhoffs GMMJ, Bleys RLAW, Have I, Bekerom MPJ. Clinical relevance of the anatomy of the long head bicipital groove, an evidence-based review. Clin Anat. 2021;34(2):199–208.
Calvert E, Chambers GK, Regan W, Hawkins RH, Leith JM. Special physical examination tests for superior labrum anterior posterior shoulder tears are clinically limited and invalid: a diagnostic systematic review. J Clin Epidemiol. 2009;62(5):558–63.
Gismervik S, Drogset JO, Granviken F, Rø M, Leivseth G. Physical examination tests of the shoulder: A systematic review and meta-analysis of diagnostic test performance.BMC Musculoskeletal Disorders. 2017;18(1).
Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT 3, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med. 2008;42(2):80–92. discussion.
Innocenti T, Ristori D, Miele S, Testa M. The management of shoulder impingement and related disorders: a systematic review on diagnostic accuracy of physical tests and manual therapy efficacy. J Bodyw Mov Ther. 2019;23(3):604–18.
Dessaur WA, Magarey ME. Diagnostic accuracy of clinical tests for superior labral anterior posterior lesions: a systematic review. J Orthop Sports Phys Therapy. 2008;38(6):341–52.
Munro W, Healy R. The validity and accuracy of clinical tests used to detect labral pathology of the shoulder–a systematic review. Man Ther. 2009;14(2):119–30.
Mirkovic M, Green R, Taylor N, Perrott M, ACCURACY OF CLINICAL TESTS, TO DIAGNOSE SUPERIOR LABRAL ANTERIOR AND POSTERIOR (SLAP) LESIONS. Phys Therapy Reviews. 2005;10(1):5–14.
Meserve BB, Cleland JA, Boucher TR. A meta-analysis examining clinical test utility for assessing superior labral anterior posterior lesions. Am J Sports Med. 2009;37(11):2252–8.
Powell JW, Huijbregts PA, Jensen R. Diagnostic utility of clinical tests for SLAP lesions: a systematic literature review. J Man Manipulative Therapy. 2008;16(3):58E–79E.
Sandrey MA. Special physical examination tests for superior labrum anterior-posterior shoulder tears: an examination of clinical usefulness. J Athl Train. 2013;48(6):856–8.
Lewis J, McCreesh K, Roy JS, Ginn K. Rotator Cuff Tendinopathy: navigating the diagnosis-management conundrum. J Orthop Sports Phys Ther. 2015;45(11):923–37.
Lehman GJ. The role and value of Symptom-Modification Approaches in Musculoskeletal Practice. J Orthop Sports Phys Ther. 2018;48(6):430–5.
Ostrowski JL, Beaumont A, Dochterman E. Diagnostic Accuracy of Musculoskeletal Ultrasound on Long Head Biceps Tendon Pathologies.J Sport Rehabil. 2021:1–4.
Castro BKC, Corrêa FG, Maia LB, Oliveira VC. Effectiveness of conservative therapy in tendinopathy-related shoulder pain: a systematic review of randomized controlled trials. Phys Ther Sport. 2021;49:15–20.
Ainsworth R. Physiotherapy rehabilitation in patients with massive, irreparable rotator cuff tears. Musculoskelet Care. 2006;4(3):140–51.
Pogorzelski J, Fritz EM, Godin JA, Imhoff AB, Millett PJ. Nonoperative treatment of five common shoulder injuries: a critical analysis. Obere Extrem. 2018;13(2):89–97.
Tallia AF, Cardone DA. Diagnostic and therapeutic injection of the shoulder region. Am Fam Physician. 2003;67(6):1271–8.
Gleich J, Milz S, Ockert B. [Principles of tendon healing at the shoulder and consequences for their treatment: importance of platelet-rich plasma and regenerative medicine]. Unfallchirurg. 2021;124(2):89–95.
Fadale PD, Wiggins ME. Corticosteroid injections: their use and abuse. J Am Acad Orthop Surg. 1994;2(3):133–40.
Allen GM. The diagnosis and management of shoulder pain. J Ultrason. 2018;18(74):234–9.
Kreuz PC, Steinwachs M, Angele P. Single-dose local anesthetics exhibit a type-, dose-, and time-dependent chondrotoxic effect on chondrocytes and cartilage: a systematic review of the current literature. Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA. 2018;26(3):819–30.
Piper SL, Kim HT. Comparison of Ropivacaine and Bupivacaine toxicity in human articular chondrocytes. J bone joint Surg Am volume. 2008;90(5):986–91.
Aldon-Villegas R, Perez-Cabezas V, Chamorro-Moriana G. Efficacy of management of associated dysfunctions on rotator cuff and long head of the biceps: systematic review. J Orthop Surg Res. 2021;16(1):501.
Kim YS, Jeong JY, Lee HJ. Arthroscopic tenodesis of the long head of the Biceps Tendon. JBJS Essent Surg Tech. 2017;7(3):e19.
Diercks R, Bron C, Dorrestijn O, Meskers C, Naber R, de Ruiter T, et al. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the dutch Orthopaedic Association. Acta Orthop. 2014;85(3):314–22.
Moorthy V, Tan AHC. Should long head of biceps tenodesis or tenotomy be routinely performed in arthroscopic rotator cuff repairs? J Orthop. 2020;21:161–5.
Hamzeh Khundaqji (HK) performed an independent assessment and verification of the level of evidence for each article.
Ethics approval and consent to participate
Consent for publication
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Diplock, B., Hing, W. & Marks, D. The long head of biceps at the shoulder: a scoping review. BMC Musculoskelet Disord 24, 232 (2023). https://doi.org/10.1186/s12891-023-06346-5
- Long head of biceps
- Scoping review