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Acta Orthop Belg 2021 Dec;87(4):765-769

A challenging complication of arthroscopic biceps surgery is the persistent painful cramping of the biceps. There is a paucity of data upon nonsurgical treatment of this debilitating complication. We pro- pose an intramuscular injection of botulinum toxin A (BTX-A) for painful bicipital cramping after tenotomy of the long head of the biceps brachii tendon (LHBT). Read More

JBJS Rev 2021 10 25;9(10). Epub 2021 Oct 25.

Rothman Orthopaedic Institute, Philadelphia, Pennsylvania.

»: Pathology of the long head of the biceps tendon is a common source of shoulder pain and often occurs in combination with other shoulder disorders.

»: Nonsurgical management, including rest and activity modification, use of nonsteroidal anti-inflammatory drugs, physical therapy, and corticosteroid injections, is usually the first line of treatment.

»: Patients with symptoms that are refractory to nonsurgical management are indicated for biceps tenotomy or various tenodesis procedures. Read More

Arthroscopy 2021 06 13;37(6):1711-1716. Epub 2021 Jan 13.

Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, U.S.A.

Purpose: To evaluate the frequency of glenohumeral joint extravasation of ultrasound (US)-guided biceps tendon sheath injections.

Methods: Fifty shoulders with a clinical diagnosis of bicipital tenosynovitis pain received a US-guided biceps sheath injection with anesthetic, steroid, and contrast (5.0 mL mixture) followed immediately by orthogonal radiographs to localize the anatomic distribution of the injection. Read More

IEEE Trans Neural Syst Rehabil Eng 2020 07;28(7):1642-1650

Spasticity is a major impairment that can occur following a hemispheric stroke and is often treated with injections of botulinum toxin, a neurotoxin that impairs transmission at the neuromuscular junction. Hyperreflexia is a defining feature of spasticity. Our main objective here was to quantify the time course of changes in the deep tendon reflex (DTR) responses and voluntary activation capacity following BT injection as well as to track changes in a clinical assessment of spasticity. Read More

Arch Bone Jt Surg 2019 Nov;7(6):493-497

Department of Orthopaedic Surgery, Division of Shoulder Surgery and Sports Medicine, University of Pittsburgh, UPMC Center for Sports, Pittsburgh, PA, USA.

Background: To describe a case series of young adult patients with isolated chronic proximal biceps tendinitis refractory to conservative care found to have anatomic long head biceps tendon (LHBT) origin variations who underwent arthroscopic-assisted subpectoral biceps tenodesis.

Methods: Patients were included in this retrospective case series if they met all the following criteria: 1) had an anomalous origin of the LHBT without any pre-operative or concurrent pathologies at the time of surgery, 2) had non-traumatic anterior shoulder pain refractory to conservative care for >6 months, 3) pain relief with ultrasound guided steroid injections into the bicipital tendon sheath, and 4) routine radiographs and MRI-arthrogram demonstrating no pathology. All patients underwent arthroscopic assisted mini-open subpectoral biceps tenodesis. Read More

J Comput Assist Tomogr 2019 May/Jun;43(3):519-523

H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Center for Trauma Rehabilitation Research, Houston, TX.

The sonographic appearance of soft tissue can be altered with movement. This can be related to both position change as well as torsional stress. The objective of this article is to demonstrate sonographic anatomy of the anterior shoulder as it moves into full external rotation. Read More

J Back Musculoskelet Rehabil 2019 ;32(2):355-359

Department of Rehabilitation Medicine, Daegu Veterans Health Service Medical Center, Daegu, Korea.

Background And Objective: Calcific tendinitis is commonly found in the rotator cuff; however, it is very rare in the long biceps tendon (LBT). Furthermore, calcific tendinitis involving the LBT in the hemiplegic shoulder after a stroke has not been previously reported.

Materials And Method: We present a case of a 63-year-old man who suffers from a stroke and atypical calcific tendinitis involving the LBT as a rare cause of hemiplegic shoulder pain. Read More

Pain Med 2019 01;20(1):138-142

Division of Anatomy, University of Toronto, Toronto, ON, Canada.

Objective: Long head biceps tendon peritendinous or sheath injections are routinely administered at or immediately distally to the bicipital groove. The main indication for injection remains the clinical diagnosis or treatment of biceps tendinopathy, although true inflammation of the tendon within the bicipital groove is rare. Because the tendon sheath is merely an extension of the joint cavity, it is plausible to assume that an injection into the sheath would result in intraarticular spread. Read More

Am J Phys Med Rehabil 2018 Jan;97(1):56-61

From the Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York (SWL, TT, BL, MNB); Hofstra Northwell School of Medicine, Hofstra University, Hempstead, New York (JR); and Kessler Institute for Rehabilitation, Kessler Foundation, Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Neward, New Jersey (MO-P).

Objective: The aims of the study were to assess the overall reduction of pain in patients undergoing ultrasound-guided shoulder injections and to characterize the preinjection point-of-care ultrasound findings and use of clinical services postinjection including the use of magnetic resonance imaging and surgeries.

Design: Data of 172 patients who underwent ultrasound-guided subacromial subdeltoid injection or glenohumeral joint injection were reviewed for preinjection point-of-care ultrasound findings, change in pain intensity at 2 mos from baseline, and use of care at 6 mos' postinjection. Pain intensity was measured by the numeric rating scale and a dichotomous report of global impression of significant improvement in pain. Read More

Curr Probl Diagn Radiol 2017 Nov - Dec;46(6):415-418. Epub 2017 Feb 16.

Division of Musculoskeletal Radiology, Department of Radiology, University of Colorado School of Medicine, Aurora, CO. Electronic address:

The purpose of this investigation was to better define the anatomical features of the biceps tendon sheath, including the distance the sheath extends below the inferior margin of the subscapularis tendon and below the termination of the bony bicipital groove. A total of 110 magnetic resonance and computed tomography arthrograms performed during 1-year period at our institution were retrospectively reviewed, and the length of the biceps tendon sheath and distances from the inferior margin of the subscapularis tendon and from the termination of the bicipital groove to the inferior margin of the biceps tendon sheath were measured by 3 radiologists. The mean length of the biceps tendon sheath was 47. Read More

J Shoulder Elbow Surg 2017 Aug 27;26(8):1416-1422. Epub 2017 Mar 27.

Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA. Electronic address:

Background: Arthroscopic examination of the tendon has been described as the "gold standard" for diagnosis of tendinitis of the long head of the biceps (LHB). An arthroscopic finding of an inflamed and hyperemic LHB within the bicipital groove has been described as the "lipstick sign." Studies evaluating direct visualization in diagnosis of LHB tendinitis are lacking. Read More

Vet Surg 2016 May 7;45(4):523-8. Epub 2016 Apr 7.

Department of Clinical Veterinary Sciences, United Kingdom.

Objective: To describe the volume and dimensions of the bicipital bursa and its position in relation to bony and soft tissue structures, in order to develop a novel medial synoviocentesis approach to the bicipital bursa.

Study Design: Cadaveric study.

Animals: Adult equine cadaver limbs (n=19). Read More

Vet Rec 2012 Dec 1;171(23):596. Epub 2012 Nov 1.

Department of Medicine and Surgery, University of Murcia, Campus de Espinardo, Murcia 30100, Spain.

Forces exerted by fibrous structures on the medial aspect of the canine elbow joint have been reported to be involved in elbow pathology. The purpose of this paper is to assess the relationships of the ligamentous and muscular structures of this region of the canine elbow joint, and how they relate to the medial coronoid process. Six cadavers of adult German shepherd cross-breed dogs were used in this study to make intra-articular and vascular injections of this region. Read More

Top Spinal Cord Inj Rehabil 2012 ;18(1):77-8

Principle Investigator, Georgetown University School of Medicine, Department of Rehabilitation Medicine, National Rehabilitation Hospital , Washington, DC.

The purpose of study is to explore the efficacy and safety of platelet rich plasma (PRP) in the nonoperative management of shoulder tendinopathy amongst individuals with spinal cord injury. This objective was met by completing a pilot study on the effectiveness and safety of a PRP injection into the biceps tendon demonstrating clinical and ultrasonagraphic pathology. Recent analysis of the preliminary pilot data has demonstrated remarkably convincing results demonstrating both the safety and efficacy of this novel intervention. Read More

PM R 2011 Nov 25;3(11):1035-40. Epub 2011 Jun 25.

Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN, USA.

Objective: To determine the accuracy of palpating the long head of the biceps tendon (LHBT) within the intertubercular groove with the use of ultrasonographic localization as a gold standard.

Design: Prospective, single-blinded pilot study.

Setting: Sports medicine clinic at a tertiary care academic institution. Read More

Pain Pract 2011 Jul-Aug;11(4):392-6. Epub 2010 Nov 28.

Division of Physical Medicine and Rehabilitation, Stanford University School of Medicine, Palo Alto, California, USA.

Background: The management of bicipital tendonitis can be challenging to the clinician. Traditionally, blind injections near the bicipital groove have been performed by clinicians with risk of bicipital tendon rupture or atrophy. Because of the inaccuracy and risk associated with blind bicipital tendon steroid injections, we sought to ascertain whether a fluoroscopically guided steroid injection into the region of the origin of the long head of the bicipital tendon (supraglenoid tubercle) was efficacious. Read More

J Comput Assist Tomogr 2009 Sep-Oct;33(5):814-7

Department of Physical Medicine and Rehabilitation, Quentin Mease Hospital, Suite No. 240, 3601 N MacGregor, Houston, TX 77004, USA.

This is the first in a series of papers on procedure-oriented joint anatomy. This paper will review anatomy of the shoulder joint and focus on non-imaging-guided procedures. Needle procedures of the shoulder include glenohumeral, subacromial, and acromioclavicular joint injections; electromyography; trigger point and other intramuscular injections; bicipital tendon sheath injection; suprascapular nerve blocks; and botulinum toxin injections. Read More

Am Fam Physician 2009 Sep;80(5):470-6

St. Luke's Hospital/The University of Toledo, Family Medicine Residency Program, Toledo, Ohio 43614, USA.

Biceps tendinitis is inflammation of the tendon around the long head of the biceps muscle. Biceps tendinosis is caused by degeneration of the tendon from athletics requiring overhead motion or from the normal aging process. Inflammation of the biceps tendon in the bicipital groove, which is known as primary biceps tendinitis, occurs in 5 percent of patients with biceps tendinitis. Read More

Equine Vet J 2007 Jul;39(4):356-9

Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama 36849, USA.

Reasons For Performing Study: Centesis of the bicipital bursa using an 8.9 cm long spinal needle has been reported but the alternative of employing a 3.8 cm long hypodermic needle requires validation. Read More

Vaccine 2007 Jan 8;25(4):585-7. Epub 2006 Sep 8.

Queen of the Valley Hospital, Napa, CA 94558, USA.

We present two cases of shoulder pain and weakness following influenza and pneumococcal vaccine injections provided high into the deltoid muscle. Based on ultrasound measurements, we hypothesize that vaccine injected into the subdeltoid bursa caused a periarticular inflammatory response, subacromial bursitis, bicipital tendonitis and adhesive capsulitis. Resolution of symptoms followed corticosteroid injections to the subacromial space, bicipital tendon sheath and glenohumeral joint, followed by physical therapy. Read More

Joint Bone Spine 2004 Nov;71(6):592-4

Rheumatology Department, Caen Teaching Hospital, Avenue de la côte de Nacre, 14033 Caen, France.

A patient presented with an atypical pattern of acute severe shoulder pain. Sonography elucidated the mechanism of the pain and allowed effective treatment. The patient was unable not only to move her shoulder but also to flex and to extend her elbow. Read More

Chir Narzadow Ruchu Ortop Pol 2004 ;69(4):273-7

Klinika Chirurgii Ogólnej i Chirurgii Reki, Pomorska Akademia Medyczna w Szczecinie.

Unlabelled: Algodystrophy typically affects distal parts of upper extremity: the hand and the wrist. Some patients, however, complain of pain and limited mobility in shoulder joint and these symptoms are not related to predisposed injury but appear secondary in the course of the condition. Cause and pathogenesis of this disorder in unknown. Read More

Clin Nucl Med 1999 Dec;24(12):915-20

Department of Nuclear Medicine, Concord Hospital, Sydney, Australia.

Purpose: Weight lifting is now a standard part of training in most sports. An increasing number of amateur athletes are doing strength training, mostly in unsupervised situations. A series of injuries in amateur weight lifters was analyzed by bone scintigraphy, with the aim of depicting specific patterns that would accurately identify the primary lesions. Read More

AJR Am J Roentgenol 1998 Mar;170(3):599-605

Department of Radiology, Johannes Gutenberg-University Mainz, Germany.

Objective: The purpose of this study was to analyze the anatomic relationship between the superior labrum, the superior glenoid rim, the superior glenohumeral ligament, and the long head of the biceps tendon.

Materials And Methods: Seventeen cadaveric shoulder specimens underwent axial, oblique coronal, and oblique sagittal MR imaging on a 1.5-T imager. Read More

AJR Am J Roentgenol 1997 Apr;168(4):947-50

Department of Radiology, University Hospital of Basle, Switzerland.

Objective: MR arthrograms were retrospectively reviewed for susceptibility artifacts induced by accidental injection of a small amount of gas when paramagnetic contrast solution was injected. A pitfall to interpretation, an unusual distribution of intraarticular gas into the sheath of the long biceps tendon that resembled a rope ladder, was observed and compared with findings of bicipital tenosynovitis.

Conclusion: Intraarticular gas contamination during MR arthrography must be differentiated from intraarticular loose bodies and findings of bicipital tenosynovitis. Read More

Am Fam Physician 1996 Apr;53(5):1637-47

Munson Army Community Hospital, Fort Leavenworth, Kansas, USA.

Many different shoulder disorders cause similar symptoms and pain patterns. An accurate diagnosis can generally be made by obtaining a detailed history, performing a comprehensive, directed physical examination and obtaining selected radiographs. Occasionally, shoulder injections can be of great assistance in establishing a clear diagnosis and providing relief of symptoms. Read More

J Am Vet Med Assoc 1995 Jul;207(2):201-7

Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul 55108, USA.

Medical records of 23 dogs with unilateral and 3 dogs with bilateral chronic bicipital tenosynovitis were reviewed. Mean age of affected dogs was 4.6 years (SD, 2. Read More

Arch Phys Med Rehabil 1995 Mar;76(3):239-42

Department of Surgery, University Hospital Nijmegen, The Netherlands.

Five hundred forty-one patients with reflex sympathetic dystrophy (RSD) of the upper extremity were prospectively studied. One hundred fifteen patients complained of pain and/or limited range of motion in the shoulder. Shoulder complaints more often occurred in women (p = . Read More

J Vasc Interv Radiol 1994 Mar-Apr;5(2):305-8

Department of Radiology, University of Tennessee, Memphis College of Medicine 38163.

Purpose: Adhesive capsulitis involving the glenohumeral joint (frozen shoulder) is an insidious and painful condition that results in gradual loss of joint motion. Recovery is frequently prolonged despite multiple therapeutic maneuvers. The authors investigate the mechanism of action and the long-term clinical result of distention arthrography for the treatment of patients with frozen shoulder. Read More

J Gen Intern Med 1992 May-Jun;7(3):328-39

Oregon Health Sciences University, Portland Veterans Affairs Medical Center.

Painful shoulder conditions are common primary care problems. Providers should learn the topographical landmarks about the shoulder and understand shoulder mechanics. A careful clinical evaluation will usually provide a likely diagnosis. Read More