Long Head Biceps Tendon Rupture

Long head of biceps tendon (LHBT) rupture is a mainly degenerative injury of middle-aged and older adults, usually the end point of chronic bicipital tendinopathy and rotator cuff disease.

The classic story is a sudden snap during a trivial lift, followed by a distal bulge of the biceps muscle belly (the Popeye deformity). Pain often improves after rupture because the degenerate tendon is no longer loaded, and function is only modestly affected. Non-operative management is the default.

The LHBT arises from the supraglenoid tubercle and superior labrum, crosses the glenohumeral joint and leaves through the rotator interval into the bicipital groove. It is intra-articular but extra-synovial.

Stabilisers in the groove:

• •Biceps pulley: coracohumeral and superior glenohumeral ligaments with fibres of supraspinatus and subscapularis
• •Subscapularis tendon: the principal medial stabiliser
• •Transverse humeral ligament: the superficial roof

A relatively hypovascular zone at the groove predisposes to attritional change. Chronic tendinopathy, often with cuff or subscapularis disease, leads to rupture, and subluxation or medial dislocation of the tendon may come first. Autotenodesis (the scarred tendon stuck in the groove) can mask the Popeye deformity after complete rupture.

Risk factors: middle age, rotator cuff disease, overhead occupation or sport, previous corticosteroid injection near the groove, smoking and fluoroquinolone exposure.