Fig. 25.1
Diagram showing the long head of biceps and its relationship with supraspinatus and subscapularis muscles (Reproduced with permission from Philip Peng Educational Series)
Sonoanatomy
The patient is examined in sitting position with hand supinate and arm in slight external rotation. A high-frequency (6–13 MHz) linear probe is placed over the bicipital groove halfway between the clavicle and anterior axillary fold (Fig. 25.2). The biceps tendon appears as a hyperechoic or hypoechoic structure depending on the tilting angle of the probe (anisotropic effects) (Fig. 25.3). With light pressure on the probe, Doppler scan may reveal the ascending branch of the anterior circumflex artery (Fig. 25.4).
Fig. 25.2
Sonogram of the long head of biceps (*) in the bicipital groove. Note that the tendon appears hyperechoic. The insert shows the position of the patient and the ultrasound probe. LT lesser tubercle, GT greater tubercle (Reproduced with permission from Philip Peng Educational Series)
Fig. 25.3
Sonogram similar to Fig. 25.2 except a different tilt of the ultrasound probe. As a result, the long head of biceps (*) look hypoechoic. SC subscapularis (Reproduced with permission from Philip Peng Educational Series)
Fig. 25.4
Doppler scan of the long head of biceps which shows the ascending branch of anterior circumflex artery (Reproduced with permission from Philip Peng Educational Series)
Patient Selection
Primary biceps tendinitis is uncommon. Usually it is associated with other shoulder pathology. The main indication for the peritendon injection of the LHB tendon is biceps tendinopathy, which refers to a spectrum of pathology ranging from inflammatory tendinitis and tenosynovitis to degenerative tendinosis. Patient with biceps tendinitis presents with anterior shoulder pain. Tenderness in the bicipital grove is the most common finding. Different provocative tests (Speed test, Yergason test) have been described but are limited by the specificity and sensitivity.
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