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Biceps Tendinopathy, Shoulder
Michael J. Tuite, MD; Soterios Gyftopoulos, MD, MSc; Donna G. Blankenbaker, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Biceps tendon (BT)
            • Synonyms

              • Long head biceps tendinosis or tendonitis
            • Definitions

              • Mucoid change, microscopic tears within BT
              • 2 types appear similar on MR
                • Painful tendinopathy
                  • Usually associated with tenosynovitis
                  • Difficult for surgeon to see tendinopathy; usually diagnose synovitis in BT sheath
                • Degenerative tendinopathy
                  • Often asymptomatic
                  • May also have lipoid change within tendon

            IMAGING

            • General Features

              • Radiographic Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Burke CJ et al: MRI, arthroscopic and histopathologic cross correlation in biceps tenodesis specimens with emphasis on the normal appearing proximal tendon. Clin Imaging. 54:126-32, 2019
                                          2. Tadros AS et al: Long head of the biceps brachii tendon: unenhanced MRI versus direct MR arthrography. Skeletal Radiol. 44(9):1263-72, 2015
                                          3. Seo JB et al: Sonoelastography findings of biceps tendinitis and tendinosis. J Ultrasound. 17(4):271-7, 2014
                                          4. Buck FM et al: Degeneration of the long biceps tendon: comparison of MRI with gross anatomy and histology. AJR Am J Roentgenol. 193(5):1367-75, 2009
                                          5. Gaskin CM et al: Focal partial tears of the long head of the biceps brachii tendon at the entrance to the bicipital groove: MR imaging findings, surgical correlation, and clinical significance. Skeletal Radiol. 38(10):959-65, 2009
                                          6. Gaskin CM et al: Anomalies of the long head of the biceps brachii tendon: clinical significance, MR arthrographic findings, and arthroscopic correlation in two patients. Skeletal Radiol. 36(8):785-9, 2007
                                          7. Lin A et al: Magnetic resonance imaging of the long head of the biceps tendon: benefit of coplanar image. J Comput Assist Tomogr. 31(4):642-8, 2007
                                          8. Morag Y et al: MR arthrography of rotator interval, long head of the biceps brachii, and biceps pulley of the shoulder. Radiology. 235(1):21-30, 2005
                                          9. Beall DP et al: Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff. AJR Am J Roentgenol. 180(3):633-9, 2003
                                          10. Beltran J et al: Shoulder: labrum and bicipital tendon. Top Magn Reson Imaging. 14(1):35-49, 2003
                                          11. Martinoli C et al: US of the shoulder: non-rotator cuff disorders. Radiographics. 23(2):381-401; quiz 534, 2003
                                          12. Spritzer CE et al: Assessment of instability of the long head of the biceps tendon by MRI. Skeletal Radiol. 30(4):199-207, 2001
                                          13. De Maeseneer M et al: CT and MR arthrography of the normal and pathologic anterosuperior labrum and labral-bicipital complex. Radiographics. 20 Spec No:S67-81, 2000
                                          14. Ho CP: MR imaging of rotator interval, long biceps, and associated injuries in the overhead-throwing athlete. Magn Reson Imaging Clin N Am. 7(1):23-37, 1999
                                          15. Weishaupt D et al: Lesions of the reflection pulley of the long biceps tendon. MR arthrographic findings. Invest Radiol. 34(7):463-9, 1999
                                          16. Yeh L et al: Intracapsular origin of the long head of the biceps tendon. Skeletal Radiol. 28(3):178-81, 1999
                                          17. Gückel C et al: MR arthrographic findings in tenosynovitis of the long bicipital tendon of the shoulder. Skeletal Radiol. 27(1):7-12, 1998
                                          18. Kreitner KF et al: Superior labrum and labral-bicipital complex: MR imaging with pathologic-anatomic and histologic correlation. AJR Am J Roentgenol. 170(3):599-605, 1998
                                          19. Zanetti M et al: Tendinopathy and rupture of the tendon of the long head of the biceps brachii muscle: evaluation with MR arthrography. AJR Am J Roentgenol. 170(6):1557-61, 1998
                                          20. Nidecker A et al: Imaging the long head of biceps tendon--a pictorial essay emphasizing magnetic resonance. Eur J Radiol. 25(3):177-87, 1997
                                          21. Tuckman GA: Abnormalities of the long head of the biceps tendon of the shoulder: MR imaging findings. AJR Am J Roentgenol. 163(5):1183-8, 1994
                                          22. van Leersum M et al: Magnetic resonance imaging of the biceps complex. Magn Reson Imaging Clin N Am. 1(1):77-86, 1993
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Biceps tendon (BT)
                                                    • Synonyms

                                                      • Long head biceps tendinosis or tendonitis
                                                    • Definitions

                                                      • Mucoid change, microscopic tears within BT
                                                      • 2 types appear similar on MR
                                                        • Painful tendinopathy
                                                          • Usually associated with tenosynovitis
                                                          • Difficult for surgeon to see tendinopathy; usually diagnose synovitis in BT sheath
                                                        • Degenerative tendinopathy
                                                          • Often asymptomatic
                                                          • May also have lipoid change within tendon

                                                    IMAGING

                                                    • General Features

                                                      • Radiographic Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Staging, Grading, & Classification

                                                                    • Gross Pathologic & Surgical Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Burke CJ et al: MRI, arthroscopic and histopathologic cross correlation in biceps tenodesis specimens with emphasis on the normal appearing proximal tendon. Clin Imaging. 54:126-32, 2019
                                                                                  2. Tadros AS et al: Long head of the biceps brachii tendon: unenhanced MRI versus direct MR arthrography. Skeletal Radiol. 44(9):1263-72, 2015
                                                                                  3. Seo JB et al: Sonoelastography findings of biceps tendinitis and tendinosis. J Ultrasound. 17(4):271-7, 2014
                                                                                  4. Buck FM et al: Degeneration of the long biceps tendon: comparison of MRI with gross anatomy and histology. AJR Am J Roentgenol. 193(5):1367-75, 2009
                                                                                  5. Gaskin CM et al: Focal partial tears of the long head of the biceps brachii tendon at the entrance to the bicipital groove: MR imaging findings, surgical correlation, and clinical significance. Skeletal Radiol. 38(10):959-65, 2009
                                                                                  6. Gaskin CM et al: Anomalies of the long head of the biceps brachii tendon: clinical significance, MR arthrographic findings, and arthroscopic correlation in two patients. Skeletal Radiol. 36(8):785-9, 2007
                                                                                  7. Lin A et al: Magnetic resonance imaging of the long head of the biceps tendon: benefit of coplanar image. J Comput Assist Tomogr. 31(4):642-8, 2007
                                                                                  8. Morag Y et al: MR arthrography of rotator interval, long head of the biceps brachii, and biceps pulley of the shoulder. Radiology. 235(1):21-30, 2005
                                                                                  9. Beall DP et al: Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff. AJR Am J Roentgenol. 180(3):633-9, 2003
                                                                                  10. Beltran J et al: Shoulder: labrum and bicipital tendon. Top Magn Reson Imaging. 14(1):35-49, 2003
                                                                                  11. Martinoli C et al: US of the shoulder: non-rotator cuff disorders. Radiographics. 23(2):381-401; quiz 534, 2003
                                                                                  12. Spritzer CE et al: Assessment of instability of the long head of the biceps tendon by MRI. Skeletal Radiol. 30(4):199-207, 2001
                                                                                  13. De Maeseneer M et al: CT and MR arthrography of the normal and pathologic anterosuperior labrum and labral-bicipital complex. Radiographics. 20 Spec No:S67-81, 2000
                                                                                  14. Ho CP: MR imaging of rotator interval, long biceps, and associated injuries in the overhead-throwing athlete. Magn Reson Imaging Clin N Am. 7(1):23-37, 1999
                                                                                  15. Weishaupt D et al: Lesions of the reflection pulley of the long biceps tendon. MR arthrographic findings. Invest Radiol. 34(7):463-9, 1999
                                                                                  16. Yeh L et al: Intracapsular origin of the long head of the biceps tendon. Skeletal Radiol. 28(3):178-81, 1999
                                                                                  17. Gückel C et al: MR arthrographic findings in tenosynovitis of the long bicipital tendon of the shoulder. Skeletal Radiol. 27(1):7-12, 1998
                                                                                  18. Kreitner KF et al: Superior labrum and labral-bicipital complex: MR imaging with pathologic-anatomic and histologic correlation. AJR Am J Roentgenol. 170(3):599-605, 1998
                                                                                  19. Zanetti M et al: Tendinopathy and rupture of the tendon of the long head of the biceps brachii muscle: evaluation with MR arthrography. AJR Am J Roentgenol. 170(6):1557-61, 1998
                                                                                  20. Nidecker A et al: Imaging the long head of biceps tendon--a pictorial essay emphasizing magnetic resonance. Eur J Radiol. 25(3):177-87, 1997
                                                                                  21. Tuckman GA: Abnormalities of the long head of the biceps tendon of the shoulder: MR imaging findings. AJR Am J Roentgenol. 163(5):1183-8, 1994
                                                                                  22. van Leersum M et al: Magnetic resonance imaging of the biceps complex. Magn Reson Imaging Clin N Am. 1(1):77-86, 1993