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Revista Română de Anatomie funcţională şi clinică, macro- şi microscopică şi de Antropologie
ORIGINAL PAPERS
Vol. XIII – Nr. 2 – 2014
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CONSIDERATIONS ON GLENOID LABRUM INSERTION
OF LONG HEAD OF BICEPS BRACHII MUSCLE
P.R. Melinte, I. Mindrilă, O.M.Marginean, Rodica Croitoru
University of Medicine and Pharmacy, Craiova
Department of Morphological Sciences
CONSIDERATIONS ON GLENOID LABRUM INSERTION OF LONG HEAD OF BICEPS
BRACHII MUSCLE (Abstract): Recent improvements in clinical imaging and shoulder arthroscopy techniques has led to an increasingly number of subtle pathologies of the glenohumeral joint;
glenoid labrum and the insertion of long head of biceps brachii muscle are definitely involved.
The authors have performed a descriptive anatomic study correlated to shoulder arthroscopy findings in order to present the morphology of the labrum insertion of long head of biceps brachii
muscle. Clinical implications are discussed. Key words: SHOULDER, ARTHROSCOPY,
LABRUM, BICEPS BRACHII MUSCLE.
The improvement in clinical imaging and the
development of shoulder arthroscopy over the
last years has allowed clinicians to diagnose and
treat more subtle pathologies of the glenohumeral joint. Injuries to the labrum have been
more recognized during this period, as a source
of symptoms and the optimal treatment of these
lesions is still evolving at a rapid pace.
The tendon of the long head of Biceps brachii muscle has been described in most anatomical texts as originating from the supraglenoid
tubercle (10, 21, 9, 19, 8, 15, 16), other studies have however shown its additional attachment to glenoid labrum (5, 20, 18, 11, 12, 3).
The purpose of the present study was to
define the extent of the labral attachment of the
tendon of biceps brachii.
MATERIAL AND METHODS
We conducted our morphologic study into
two directions: direct examination of labrum
disposition and morphology during shoulder
arthroscopy and anatomic description after dissection on human cadavers. We performed a
total number of 53 shoulder arthroscopies in
the orthopedic department of Saint Joseph Hospital in Arlon, Belgium and at Irina Medical
Center in Craiova, Romania; all patients underwent an anterior and posterior arthroscopic
approach for different shoulder pathologies
(Bankart lesions, instability, SLAP lesions etc.).
In our descriptive anatomy study, we used 21
shoulder joints from adult cadavers of both
sexes, in the Human Anatomy Department of
the University of Medicine and Pharmacy from
Craiova. The joint cavity was exposed by a
delto-pectoral approach. The long head of biceps was dissected and its attachment studied.
In order to better present the results, the glenoid cavity was divided into three topographic
parts: upper, middle and lower (14).
RESULTS
The biceps tendon was seen to arise from
the supraglenoid tubercle and extended onto the
glenoid labrum (both anteriorly and posteriorly) in all the specimens, although the extent
of this labral attachment is variable (fig. 1 and
2). An anterior labral attachment was observed
in 100% of the shoulder joints studied. Isolated
posterior labral attachment was seen in 57%
specimens. None of the specimens showed isolated anterior labral attachment. The anterior
and posterior labral margins were examined to
see how far the attachment extended i.e., upper,
middle or lower third (tab. I). The extension of
attachment up to lower third of posterior glenoidal labrum has been rarely reported earlier (14).
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P.R. Melinte et al.
TABLE 1
Labrum attachment of long head of biceps brachi muscle
Labrum attachment
Upper third
Middle third
Lower third
Anterior
30%
3%
0%
Posterior
32%
36%
12%
Fig. 1. Dissection of glenohumeral joint – one can easily notice the humeral head (3) the glenoid cavity
(4) and glenoid labrum with the insertion of long head of biceps brachi muscle (6); coracoid process
(1) with the origin of short head of biceps brachi (5) and pectoralis minor (7).
Fig. 2. Arthoscopic view of labrum attachment of long head of biceps brachii; anterior and posterior
labrum expansions.
DISCUSSION
The present study revealed that the tendon
of long head of biceps brachii has a dual attachment to the supraglenoid tubercle as well as
glenoid labrum which conforms to the arthroscopic analyses of Bankart (1980), Detrisac &
180
Johnson (1986), Pal et al (1991) and Cooper et
al (1992) (1, 4, 12, 3). Anatomical variations
in the labral attachment of the biceps tendon
help us to explain the association of recurrent
shoulder dislocation and labral detachment. This
aids to understand that the maximum activity
Considerations on Glenoid Labrum Insertion of Long Head of Biceps Brachii Muscle
of long tendon of biceps is in the late phase of
throwing when the shoulder is abducted and
externally rotated (7); also explains the higher
biceps activity in pitchers with known anterior
instability (6), wherein the biceps force has
been shown to increase the torsional rigidity of
the glenohumeral joint by 32% (17).
The biceps tendon courses over the head of
the humerus to continue with the labrum, thus
helping to retain the head in the glenoid fossa
and assisting the “rotator cuff’ (14). Our study
has demonstrated that in 12% of specimens the
posterior labral attachment of the tendon extended up to the lower third of the glenoid
cavity. This extensive attachment in the posterior glenoid labrum is expected to provide a
better stability to the shoulder. Boyd & Sisk (2)
have made surgical use of this labral attachment
in patients with detached posterior labrum by
combining a posterior capsulorraphy with a
transfer of tendon of long head around the neck
of the humerus and across the posterior capsule
to the posterior scapular neck (14). The tendon
may be elongated by as much as 1 cm to achieve
this procedure due to the presence of its labral
attachment.
CONCLUSIONS
The present study has successfully accomplished its purpose of demonstrating the variability of the labral attachment. In all specimens, the tendon extended posteriorly, mostly
up to the middle third of the posterior glenoid
margin. None of the specimens showed isolated anterior attachment. An understanding of
the labral attachment of the long tendon of biceps brachii muscle plays an important role in
the evaluation and surgical correction of labral
pathology.
Passage with changed clinical data
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