Chronic Long Head Biceps Tendinitis Secondary to Anomalous Origins in Young Patients: A Case Series

Background: To describe a case series of young adult patients with isolated chronic proximal biceps tendinitis refractory to conservative care found to have anatomic long head biceps tendon (LHBT) origin variations who underwent arthroscopic-assisted subpectoral biceps tenodesis. Methods: Patients were included in this retrospective case series if they met all the following criteria: 1) had an anomalous origin of the LHBT without any pre-operative or concurrent pathologies at the time of surgery, 2) had nontraumatic anterior shoulder pain refractory to conservative care for >6 months, 3) pain relief with ultrasound guided steroid injections into the bicipital tendon sheath, and 4) routine radiographs and MRI-arthrogram demonstrating no pathology. All patients underwent arthroscopic assisted mini-open subpectoral biceps tenodesis. Pre- and postoperative active range of motion (ROM), strength, visual analog scale (VAS) for pain, and subjective shoulder values (SSV) were evaluated. Statistical analysis was done using repeated measure ANOVA. Results: Seven patients mean age of 18.4 ± 3.5 years old were included in this study. Arthroscopic examination revealed anomalous origins of the LHBT in all patients with the following distribution: medial to superior labrum (x2), proximal insertion to the supraspinatus confluent with the superior labrum (x2), insertion into the superior capsular tissues at the rotator interval (x2), and bifid LHBT (x1). VAS score and SSV were significantly improved at 3 months (P<0.001 and = 0.024 respectively) and final follow-up. Conclusion: Anomalous origins of the LHBT may be a predisposing factor for chronic biceps tendinitis refractory to non-operative treatment in young adults. Biceps tenodesis seems to offer improvements in function and pain. Level of evidence: IV