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Proximal Biceps Tendon Rupture

- See:
     - Biceps Tendonitis
     - SLAP Lesions

- Discussion:
    - this tendon may have some role as a depressor of humeral head, preventing superior migration of humeral head;
    - approx 50% of all ruptures occur thru the tendon of the long head;
    - rupture is usually is usually more or less transverse and is located either w/ in shoulder joint or within the proximal part of intertubercular groove;

- Clinical Findings:
    - bunching up of biceps muscle in distal arm, (which does not go away);
    - there is minimal loss of function because short head of biceps remains attached to the coracoid process;

- MRI:
    - will show absence of the tendon in the bicipital groove;

- Non Operative Treatment:
    - patients can be treated non operatively since most will become asymptomatic after 4-6 weeks; 

- Operative Treatment (Tenodesis):
    - may be indicated for cosmesis or if shoulder reconstruction is required for other reasons;
          - patients can expect only a small increase in flexion strength (10%);
    - surgical treatment involves then excision of the intraarticular part of tendon, & fixation of remaining tendon to bicipital groove or into the coracoid process;
    - fixation to the bicipital groove is performed using "key hole technique":
          - a narrow slit is cut into the bone, just underneath a larger drill hole;
          - the biceps tendon is passed into the drill hole and is then allowed to to wedge down into the slit;
          - the main difficulty with this procedure is obtaining proper tension on the muscle tendon unit 

The role of the long head of the biceps brachii in superior stability of the glenohumeral joint.

Ultrasonographic evaluation of the rotator cuff and biceps tendon.

Tenodesis of the long head of the biceps brachii for chronic bicipital tendinitis. Long-term results.

Rupture of the tendon of the long head of the biceps brachii. Surgical versus nonsurgical treatment.

Treatment of ruptures of the long head of the biceps brachii. Soto-Hall R, Stroot JH. Am J Orthop. 1960;2:192.

Isolated Arthroscopic Biceps Tenotomy or Tenodesis Improves Symptoms in Patients with Massive Irreparable Rotator Cuff Tears.

Preventing the Popeye Deformity After Release of the Long Head of the Biceps Tendon: An Alternative Technique and Biomechanical Evaluation

Lateral Antebrachial Cutaneous Neuropathy Following the Long Head of the Biceps Rupture