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Biceps Tenotomy and Tenodesis
The long head of the biceps tendon (LHBT) runs a unique anatomic course through the anterior shoulder, ascending proximally through the intertubercular groove before turning 30° medially and posteriorly, where a “pulley” composed of the coracohumeral ligament, the superior glenohumeral ligament, the supraspinatus tendon, and the subscapularis tendon supports the LHBT. The LHBT then travels intra-articularly but extrasynovially through the glenohumeral joint and inserts onto the supraglenoid tubercle and/or superior labrum. LHBT pathology can occur at several locations through its anatomic course: in the intertubercular groove, within the glenohumeral joint, and at its attachment site. Depending on the location, the etiology of this tendinopathy may be osteophytes within the intertubercular groove, microtrauma from repetitive overhead activities, acromial morphology, internal impingement, ischemia, tendon instability, or trauma. Tendinitis and tendinosis commonly occur in association with subacromial impingement, rotator cuff pathology, tears of the anterior capsuloligamentous complex, labral tears, glenohumeral instability, and acromioclavicular arthrosis. Acutely, the tendon may be swollen and hemorrhagic, but with chronic friction and traction the tendon can become thinned, frayed, and atrophied, which can lead to tendon rupture, commonly with subsequent pain relief. The functional consequences of this rupture are unclear. The importance of the LHBT in shoulder function has been debated in the literature, with some authors arguing that contraction of the LHBT plays no role in shoulder motion or stability and others arguing that the LHBT acts as an important humeral head depressor.