ISSN: 1899-0967
Polish Journal of Radiology
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vol. 86
Musculoskeletal radiology
Original paper

Intra-articular long head of the biceps tendon: magnetic resonance-arthrography classification and review of literature

Nicola Tarallo
Maria C. Morgano
Marco Curti
Emanuela Spanò
Alessandro Castagna
Eugenio A. Genovese
1, 2, 3

The Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
Orthopedics of the Shoulder and Elbow Unit, Rozzano Hospital, Milan, Italy
Medical Clinical Center Intermedica-Columbus, Milan, Italy
Pol J Radiol 2021; 86: e93-e101
Online publish date: 2021/02/05
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Anatomical variants of the long head of the biceps (LHB) and diseases of the rotator interval structures may contribute to shoulder instability. The rotator interval and the LHB tendon are closely associated anatomic structures that confer stability to the shoulder. Anatomical variants around the origins of the long head of the biceps (LHB) are reported to occur with a frequency of 1.9-7.4%. In the past years, many authors have proposed different approaches for the identification and characterization of LHB and rotators interval. Magnetic resonance (MR) arthrography is considered the reference standard in imaging to diagnose superior shoulder diseases. However, few authors have analysed the anatomical variants and the relation between those and shoulder instability. This study aimed to identify the frequency of variants observed during arthroscopic shoulder surgeries, and to classify them based on the Dierickx classification system.

Material and methods
In 326 MR arthrograms we investigated the incidence of LHB anatomical variations and their association with shoulder diseases.

We found 252/326 (77.3%) cases of LHB free, 40/326(12.26%) cases of LHB adherent, 31/326(9.50%) cases of mesotenon, and 3/326(0.9%) cases of split biceps. The prevalence of rotator interval synovitis in the mesotenon group was greater than in the LHB-free group. Moreover, in the LHB-adherent group we observed increased incidence of sublabral recess and SLAP lesions compared with the LHB-free group.

MR-arthrography is useful in the evaluation of superior shoulder structures. A relationship exists between LHB anomalies and superior shoulder instability.


shoulder, anatomical variants, SLAP lesions, instability shoulder, long head biceps, MR arthrography

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