Selected Instructional Course Lecture   |    
Biceps Tendon and Superior Labrum Injuries: Decision-Making
F. Alan Barber, MD1; Larry D. Field, MD2; Richard K.N. Ryu, MD3
1 Plano Orthopedic and Sports Medicine Center, 5228 West Plano Parkway, Plano, TX 75093
2 Mississippi Sports Medicine and Orthopaedic Center, 1325 East Fortification Street, Jackson, MS 39202
3 533 East Micheltorena Street, Suite 204, Santa Barbara, CA 93103
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in March 2008 in Instructional Course Lectures, Volume 57. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).
An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Aug 01;89(8):1844-1855
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The biceps tendon originates from the labrum and the supraglenoid tubercle of the scapula. The structure is intraarticular yet extrasynovial. It is widest at its origin and progressively narrows as it exits the bicipital groove. The proximal one-third of the biceps tendon has a high degree of innervation, with substance P and calcitonin gene-related peptides present, suggesting a rich sympathetic network1.There is a spectrum of pathological conditions of the proximal part of the biceps, including tendinitis, SLAP (superior labrum anterior and posterior) lesions, biceps instability, and partial or complete ruptures. The origin of the long head of the biceps is variable and is approximately 9 cm long2. The proximal portion of the long head receives its blood supply primarily from the anterior circumflex humeral artery3. The biceps tendon passes posterior to the coracohumeral ligament and beneath the transverse humeral ligament as it courses distally. The capsuloligamentous structures of the rotator interval are responsible for restraining the biceps tendon within its proper anatomic location as it passes into the bicipital groove4,5. The coracohumeral ligament and the superior glenohumeral ligament are the two most important structures within the rotator interval for securing the biceps tendon2. The superior glenohumeral ligament forms an anterior sling about the biceps. The more distal transverse humeral ligament is not believed to play a primary role in securing the biceps tendon5.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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