Biceps brachialis pathology is common, particularly in the athletic and older populations. It is also commonly missed both with ultrasound and MRI, especially when the diagnosis of a rotator cuff tear has already been made. In order to understand the biceps tendon, one must be familiar with the structures of the rotator interval space. The coracohumeral ligament makes an important contribution to the layers of the supraspinatus tendon. Both the CHL and the superior glenohumeral ligament serve to bind down the intraarticular portion of the biceps tendon. Loss of integrity of either of these structures will lead to biceps instability. These so-called pulley lesions may be 1. Traumatic 2. Chronic 3. Related to rotator cuff or a combination of all three.
Biceps tendinopathy leads flattening, fraying, delamination, and ultimately failure of the tendon. Biceps tends to fail just adjacent to the supraglenoid origin, or just proximal to the bicipital groove. The latter can lead to an hour-glass appearance prior to rupture. Biceps rarely fails at the level of the bicipital groove, although absence of the tendon in the groove is a clear sign of failure. Assessment of the transverse ligament and scapularis tendon is vital in this context. Furthermore, there are helpful sonographic hints that might suggest impending biceps failure.
The aim of this presentation is to highlight biceps brachialis injuries in the shoulder. In particular, assessment of the rotator interval structures needs to be routinely assessed. Furthermore, dynamic ultrasound has a vital role in the assessment of such injuries