These markings were extended from the exit point of the tendon at the
bicipital groove to its most medial contact point on the humeral head.
Although multiple heads or bifurcation of the biceps tendon had been described previously, this is the first report and MR demonstration of this pattern of splitting and reattachment of the long head of the biceps brachii in its course in the
bicipital groove.
Caption: Figure 2: Axial T2 weighted MRI demonstrating absence of the
bicipital groove.
The lateral aspect of the
bicipital groove was exposed, while the biceps tendon was carefully protected.
Bicipital groove orientation: considerations for the retroversion of a prosthesis in fractures of the proximal humerus.
Both heads converge in short, wide, flattened, and bifascicular tendon inserting in the humerus, lateral to the
bicipital groove. The two fascicles or layers of the tendon are one anterior, formed by the clavicular head and the more superior segments of the sternal head, and one posterior, formed by the inferior segments of the sternal head.
Caption: Figure 5 An extramedullary guide that references off the
bicipital groove is positioned and pinned thus guiding the saw blade to the correct orientation for humeral head resection.
The most anterior hole was placed 5 mm posterior to the sulcus of the
bicipital groove. The second hole was placed 12.5 mm posterior to the first hole.
The antero-medial suture anchor was placed 5 mm posterior to the
bicipital groove, and the posterior-medial anchor was placed 12.5 mm posterior to the anterior anchor.
At this juncture, the tendon lies within the
bicipital groove of the humeral head until it emerges on the anterior aspect of the proximal humeral shaft.
The ascending branch of the anterior humeral circumflex enters the proximal humerus at the upper end of the
bicipital groove or via branches into the greater and lesser tuberosities.
Pain may be localized to the
bicipital groove, radiate distally to the biceps muscle belly, or radiate proximally to the deltoid or base of the neck.
