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Biceps (biceps brachii) -

M. biceps brachii, biceps brachii, big muscle , the contraction of which is very clearly visible under the skin, thanks to which even people unfamiliar with anatomy know it. The muscle proximally consists of two heads; one (long, caput longum) starts from the tuberculum supraglenoidal of the scapula with a long tendon that passes through the cavity of the shoulder joint and then lies in the sulcus intertubercularis humerus surrounded by vagina synovialis intertubercularis; the other head (short, caput breve) originates from the processus coracoideus of the scapula. Both heads, connecting, pass into an oblong, spindle-shaped abdomen, which ends in a tendon attached to the tuberositas radii. Between the tendon and tuberositas radii is a permanent synovial bag, bursa bicipitoradialis. A medially flat tendon bundle departs from this tendon, aponeurosis m. bicipitis brachii, weaving into the fascia of the forearm.

Function. Produces flexion of the forearm at the elbow joint; due to its point of attachment on the radius, it also acts as an arch support if the forearm has previously been pronated. Biceps it is thrown not only through the elbow joint, but also through the shoulder joint and can act on it, bending the shoulder, but only if the elbow joint is strengthened by contraction m. triceps. (Inn. C5-C6. N. musculocutaneus.)

They are divided into two groups: anterior (flexors), posterior (extensors). These groups are separated from each other by plates of the own fascia of the shoulder: on the medial side, the medial intermuscular septum of the shoulder, with the lateral-lateral intermuscular septum of the shoulder.

Anterior shoulder muscle group:

1. Coracobrachial muscle (m. Coracobrachialis)

From the apex of the coracoid process to the humerus below the crest of the lesser tubercle. Part of the bundles is woven into the medial intermuscular septum of the shoulder.

Functions:

Flexes the shoulder at the shoulder joint and brings it to the body;

If the shoulder is pronated, then the muscle is involved in its supination;

If the shoulder is fixed, then the muscle pulls the scapula forward and down.

2. The biceps muscle of the shoulder (m. Biceps brachii)

Has two heads:

Short head (caputBreve) begins with the coracoid shoulder muscles to her.

long head (caputlongum) starts from the supraarticular tubercle of the scapula with a tendon that penetrates the capsule of the shoulder joint and lies in the intertubercular groove, where it is fixed by the transverse ligament of the shoulder (lig. transversum humeri), stretching between the large and small tubercles of the humerus. In the joint cavity and in the groove, the tendon is surrounded by a synovial sheath (vagina tendinis intertubercularis). At the level of the middle of the shoulder, both heads are connected into a common abdomen, which is attached to the tuberosity of the radius. From the tendon to the medial side departs aponeurosis of the biceps muscle of the shoulder (aponeurosis musculi bicipitis brachii), which merges with the fascia of the forearm.

Functions:

Flexes the shoulder at the shoulder joint;

Flexes the forearm at the elbow joint;

Supinates the forearm.

3. Shoulder muscle (m. Brachialis)

It begins between the deltoid tuberosity and the articular capsule of the elbow joint, the medial and lateral muscular septa of the shoulder.

Attaches to the tuberosity of the ulna

Function: flexes the forearm at the elbow joint.

Posterior shoulder muscle group

1. The triceps muscle of the shoulder (m. Triceps brachii)

Has three heads:

Lateral head (caputlaterale) begins on the outer surface of the humerus, the bundles pass down and medially, covering the furrow of the radial nerve.

medial head (caputmediale) from rear surface shoulder

long head (caputlongum) from the subarticular tubercle of the scapula, passes down between the small and large round muscles to the middle of the back surface of the shoulder, where its bundles are connected to the medial and lateral heads. Attached to the olecranon of the ulna, part of the bundles is woven into the capsule of the elbow joint and into the fascia of the forearm.

Functions:

Extends the forearm at the elbow joint;

The long head is involved in the extension and bringing the shoulder to the body.

2. Elbow muscle (m. Anconeus)

It begins on the posterior surface of the lateral epicondyle of the shoulder.

It is attached to the lateral surface of the olecranon, the posterior surface of the ulna, the fascia of the forearm.

Function: participates in the extension of the forearm.

Fascia of the upper limb

superficial fascia upper limb It is represented by a layer of subcutaneous adipose tissue, the amount of which varies individually. The thickness of the skin fold on the back of the shoulder is one of the anthropometric indicators of obesity.

Deep (intrinsic) fascia differs in its structure in different areas of the upper limb. In the deep fascia covering the muscles of the shoulder girdle, secrete five parts.

1. Deltoid fascia (fascia deltoidea) surrounds the muscle of the same name, forms numerous partitions between its bundles; in front it connects with fascia pectoralis, behind - with fascia infraspinata, at the top it is attached to the clavicle, acromion and spine of the scapula, from below it continues into the fascia of the shoulder.

2. Supraspinous fascia (fascia supraspinata) is a thin fibrous plate, which is attached along the edges of the supraspinatus fossa of the scapula, forming a bone-fibrous case for the supraspinatus muscle, in the medial part it is thicker.

3. Infraspinatus fascia (fascia infraspinata), is a well-defined strong aponeurotic plate, attached to the scapula along the edges of the infraspinatus fossa, forms a bone-fibrous case for the infraspinatus muscle.

4. Subscapular fascia (fascia subscapularis) is a thin fibrous plate, which is attached along the edges of the scapular fossa, forms a bone-fibrous case for the subscapularis muscle.

5. Axillary fascia (fascia axillaris) It is formed as follows: the pectoral fascia in the gap between the edges of the pectoralis major muscle and the latissimus dorsi muscle thickens, forming the bottom of the axillary cavity, here it is called the axillary fascia, continues into the fascia of the shoulder.

Shoulder fascia (fascia brachii) surrounds the muscles of the shoulder; from its inner surface, two intermuscular septa extend deep into the medial and lateral (septum intermusculare brachii mediale etlaterale), attached to the humerus and separating the anterior and posterior muscle groups. The medial intermuscular septum separates the coracobrachialis muscle from the medial head of the triceps brachii. The lateral intermuscular septum separates the brachialis and brachioradialis muscles from the lateral head of the triceps muscle.

As a result, two fascial beds are formed - front (compartmentumbrachiianterius) and back (compartmentumbrachiiposterius).

Covering the anterior group of muscles of the shoulder, the fascia is divided into two plates, forming a separate fibrous case for the coracobrachial and biceps muscles and a bone-fibrous case for the shoulder muscle. Triceps shoulder lies in a separate bone-fibrous case. In the lower third of the shoulder, the medial saphenous vein of the arm (v. basilica) lies in the subcutaneous tissue, on the border with the middle third it pierces its own fascia and lies in the splitting of the fascia (Pirogov’s canal) in the middle third of the shoulder, in the upper third of the shoulder the vein goes under its own fascia and flows into one of the brachial veins.

Fascia of the forearm (fascia antebrachii) is a continuation of the deep fascia of the shoulder, it forms a tight case for all the muscles of the forearm together and for each muscle separately. The fascia of the forearm is attached to the olecranon and to the posterior edge of the ulna.

Total or partial rupture of the tendon of the long head of the biceps is not uncommon. This is a severe disorder that leads to limited movement of the upper limb. Only qualified treatment will allow in the future to fully use the hand again.

Some patients are inattentive to their health and do not rush to the traumatologist. With total damage to the tendon, the function of the limb will not fully recover if the disease is not treated, and pain will become a constant companion.

Our clinic has accumulated rich clinical experience in the treatment of such patients, which allows us to restore the function of the shoulder joint even in the most difficult cases.

Anatomy of the tendon of the biceps brachii

The biceps, or biceps, is a flexor. It consists of muscle fibers and tendon. With its contraction, the movement of the upper limb in the elbow joint occurs.

The long head of the biceps is attached to the tubercle of the scapula, and the short head is attached to its coracoid process. Both heads fuse to form a single tendon and insert into the tuberosity at the proximal end of the radius of the forearm. The biceps can not only bend the arm at the elbow joint, but also participate in rotational movements.

Fig. 1 a, b Structure of the shoulder joint (schematic representation)

The tendon of the head of the biceps brachii passes through shoulder joint and is longer than the tendon short head and therefore more prone to damage.

Causes and mechanism of rupture

A rupture of the distal biceps tendon is usually traumatic. This damage is predominantly characteristic of men, since they are more likely to lift weights and undergo intense physical exertion.

In older people, a tendon rupture of the head of the biceps can occur for no apparent reason. This is due age-related changes in the tendons, the consequences of microtraumas that have taken place throughout life. But pathology is often found in young, active men aged 35-40. Predisposing factors are tendinitis, which arose as a result of constant microtraumas.

Professional sports and some activities that involve constant stress on the biceps muscle, over time, make the anatomical structures vulnerable, and they rupture even with moderate effort.

The injury usually occurs with a sharp rise in weight, as well as with a sudden forced extension of the elbow joint. The tendon is often torn in the area of ​​​​attachment to the scapula, humeroscapular joint, or near the intertubercular groove.

Symptoms of a torn biceps tendon

In clinical practice, complete ruptures of the head of the biceps are more common. In this case, the tendon is completely torn and separated from the bone, reduced and pulled to the elbow joint.

When viewed on the inner surface of the lower third of the shoulder, a pronounced tubercle is visualized. Immediately after the injury, swelling occurs, which quickly spreads throughout the shoulder.

Fig.2 Appearance shoulder with a rupture of the long head of the biceps.

The rupture may be isolated or accompanied by damage to other structures, such as the rotator cuff. With concomitant disorders, the clinical picture is atypical.

At the time of injury, acute pain is felt, attempts to flex the elbow are painful or impossible. With a tear of the tendon, as well as trauma in the elderly, the clinical picture is erased. The pain syndrome is moderate, the flexion force is reduced.

For determining muscle tone on the side of the injury, you need to compare it with a healthy hand, since in some patients the tone may be reduced initially.

Diagnostics

Diagnosis of a rupture of the long head of the biceps is carried out in several stages. At the beginning, the doctor finds out the mechanism and circumstances of the injury, clarifies whether there were injuries before, the patient went in for sports, whether his work is associated with constant physical exertion.

After collecting an anamnesis, the orthopedic traumatologist proceeds to the examination. The doctor visually assesses the condition of the upper limb, determines if there is a hematoma, a tubercle in the distal shoulder. An important factor is the presence, localization and persistence of pain. The volume of active and passive movements of the upper limb is also determined. If the case is serious and the gap is complete, active movements are limited.

To clarify the diagnosis, determine the degree of damage, additional examination methods are connected. Ultrasound is widely used, the method allows you to accurately determine complete ruptures. MRI is used to obtain more accurate information about the localization of damage, as well as to visualize small tears and intra-articular injuries.

Fig. 3 MRI picture of a tendon rupture of the long head of the biceps

Treatment

Treatment of a ruptured head of the biceps can be either conservative or surgical.

Tactics is determined depending on the degree of damage and the individual characteristics of the patient.

Conservative therapy

Conservative treatment is indicated in the following cases:

• middle and old age;
• contraindications to surgical intervention;
• activities not related to the use of physical force;
• minor tendon injury.

After conservative therapy, the strength of supination is reduced by 20%, if the patient is not engaged in activities associated with a large load on the upper limbs, this factor does not affect the quality of life and allows you to fully serve yourself.

Surgery

Surgical treatment is indicated for young people, patients who play sports or work physically. The operation completely restores range of motion and muscle strength. The most progressive method of treatment for biceps tendon rupture is such a modern surgical method of treatment as arthroscopy.

The technique is based on the use of an arthroscope, which is inserted through small punctures, allowing a detailed examination of the damaged area with the help of optics, as well as performing the necessary manipulations to restore the tendon.

The effectiveness of the procedure is high, and the recovery period is minimal. In some cases, the technique with traditional surgical access through the incision is also used.

Rice. Fig. 4 Schematic representation of tenodesis (fixation to the head of the humerus) of the tendon of the long head of the biceps muscle with a screw (a) and an anchor (b).

Rehabilitation after surgical treatment

After restoring the anatomical integrity of the ligaments and tendons, the limb is immobilized for a period of 3-6 weeks. Physiotherapy is widely used for quick recovery and physiotherapy, which is a set of exercises to improve muscle tone and increase range of motion in the joint.

Used to activate metabolic processes and improve muscle tone massotherapy. Recovery of working capacity occurs after 6-10 weeks from the moment of injury.

Violation of the integrity of the tendon of the biceps of the shoulder is a serious injury that leads to dysfunction of the upper limb if not properly treated.

If trouble occurs, seek medical help from an orthopedic traumatologist as soon as possible. High professionalism, individual approach, ownership modern technologies, rich practical experience and a good material base allow the specialist to return patients to a full, active life.

Muscles of the free upper limb Muscles of the shoulder: anterior group

Biceps brachii

The biceps muscle of the shoulder, m. biceps brachii(see Fig. , , , , ), consists of two heads, rounded in shape, spindle-shaped. It occupies the anterior region of the shoulder and elbow and is located directly under the skin.

Long head, caput longum, occupies a lateral position. It starts as a long tendon from the supraarticular tubercle of the scapula, passes over the head of the humerus through the cavity of the shoulder joint, lies in the intertubercular groove, surrounded by intertubercular synovial vagina, vagina synovialis intertubercularis, and then passes into the muscular abdomen.

Short head, caput breve occupies a medial position. It begins with a wide tendon from the top of the coracoid process of the scapula and, heading down, also passes into the muscular abdomen.

Both heads are connected to each other into a long muscular abdomen, which narrows at the ulnar fossa and passes into a powerful tendon attached to the tuberosity of the radius. At the point of attachment of the tendon is biceps-beam bag, bursa bicipitoradialis, and between the tendons of the biceps and brachialis muscles, in the upper part of the oblique chord, where it approaches the medial surface of the ulna, lies interosseous ulnar bag, bursa cubitalis interossea.

A part of the bundles in the form of a thin plate is separated from the proximal end of the tendon - aponeurosis of the biceps muscle of the shoulder, aponeurosis m. bicipitis brachii. On the sides of m. biceps brachii on the shoulder are located medially and laterally almost symmetrically to the grooves of the shoulder, sulcus bicipitalis medialis i sulcus bicipitalis lateralis.

Function: flexes the arm at the elbow joint and supinates the forearm; due to the long head, it takes part in the abduction of the arm, due to the short one - in the adduction of the arm.

Innervation: n. musculocutaneus (C V -C VII).

Blood supply: aa. collaterales ulnares superior et inferior, a. recurrens radialis, a. brachialis.

Biceps tendonitis, or biceps tendinitis, is an inflammation of the tendon of the biceps brachii that runs in a groove on the front of the shoulder. The most common cause is chronic overuse of the tendon. Biceps tendonitis can develop gradually, or it can happen suddenly from direct trauma. Tendinitis can develop if the shoulder joint suffers from another pathology, such as damage to the glenoid labrum, shoulder instability, impingement syndrome, or a rotator cuff tear.
Anatomy

The biceps brachii muscle is located on the anterior surface of the shoulder. In the upper part, the muscle is attached to the shoulder blade through two separate tendons. These tendons are called proximal. The word "proximal" means "near".
One tendon, the tendon of the long head of the biceps, originates at the superior edge of the glenoid cavity and is associated with the articular cartilage and the labrum. The tendon then passes along the anterior surface of the head of the shoulder in its groove. The transverse ligament of the shoulder, spreading over the groove, forms a channel for the tendon and keeps it from dislocation. The tendon of the long head of the biceps is an important structure that helps keep the head of the shoulder in the center of the glenoid cavity of the scapula.
The second tendon, the tendon of the short head of the biceps, is located outward and begins on the coracoid process of the scapula.
The lower tendon of the biceps is called the distal. The word "distal" means "far". The distal biceps tendon attaches to a tubercle on the radius of the forearm. The biceps muscle itself is formed by two bellies that extend from the proximal tendons and merge with each other almost at the junction with the distal tendon.
Tendons are made up of strands of a material called collagen. Collagen threads form bundles, bundles - fibers. Collagen is a strong material and tendons have very high tensile strength. When the muscles contract, traction is transmitted to the tendons and the point of origin of the muscle approaches the point of attachment, as a result of which the bones move relative to each other.
When contracted, the biceps muscle produces flexion at the elbow joint. In the elbow joint, the radius of the forearm can make rotational movements(rotation), therefore, when contracting the biceps, she performs external rotation (supination), turning the hand palm up with the elbow joint bent, as for example holding a tray. In the shoulder joint, the biceps is involved in raising the arm forward (flexion).
Causes
Continuous or repetitive shoulder action can lead to excessive load on the biceps tendon, which causes damage to microstructures at the cellular level. If the load continues, then the damaged structures inside the tendon do not have time to recover, which leads to tendonitis, inflammation of the tendon. This is common in sports, such as in swimmers, tennis players, and also in workers when it is necessary to hold the arms above the head.
If the impact occurs for many years in a row, then the structure of the tendon changes, signs of degeneration appear, the tendon can become defibrated. The tendon is weakened and prone to inflammation, and at some point under load it can even tear.
Biceps tendinitis can occur from an injury such as a fall on the shoulder. A tear in the transverse ligament of the shoulder can also lead to biceps tendinitis. It was mentioned above that the transverse ligaments of the shoulder hold the biceps tendon in the groove on the anterior surface of the shoulder. If this ligament is torn, the biceps tendon can freely pop out of the groove, producing characteristic clicks. In addition, permanent dislocations also cause biceps tendinitis.
As mentioned above, tendonitis can occur due to other pathologies in the shoulder joint, such as damage to the glenoid labrum, shoulder instability, impingement syndrome, or a rotator cuff tear. In these conditions, the head of the shoulder is excessively mobile, so there is a constant mechanical effect on the biceps tendon, which, in turn, leads to inflammation.
Symptoms
Patients usually experience pain in the depth of the shoulder along the anterior surface. The pain may radiate downward. The pain usually worsens when the arms are raised above shoulder level. After rest, the pain usually goes away.
The hand may weaken when trying to bend the arm at the elbow joint or turn the palm up. A sharp feeling of stiffness in the upper part of the biceps may indicate damage to the transverse ligament of the biceps.
Diagnosis
The diagnosis is made on the basis of a conversation with the patient, examination and special research methods. Usually questions are asked about work activities, sports hobbies, previous shoulder injuries, pain manifestations.
Physical examination is most helpful in diagnosing biceps tendonitis. The doctor will identify pain points, check movements in the joints, determine muscle function, conduct special tests, including other pathologies, such as damage to the articular lip, shoulder instability, impingement syndrome or rotator cuff rupture.
An x-ray (radiography) is only needed to detect or rule out other diseases of the shoulder joint, such as calcific tendinitis, arthrosis of the acromioclavicular joint, impingement syndrome, instability.
When treatment for biceps tendonitis is unsuccessful, magnetic resonance imaging (MRI) may be ordered. MRI is a special imaging technique that uses magnetic waves to create a computer-generated image of the shoulder joint in standard planes. This test may help identify a rotator cuff tear or lip injury.
Treatment
Conservative treatment
Treatment begins with conservative methods. It is usually advised to limit the load and avoid the activities that led to the problem. Rest in the shoulder joint usually relieves pain and helps reduce inflammation. Anti-inflammatory medications may be prescribed to relieve pain and help patients return to normal activities. These drugs include drugs such as voltaren, diclofenac, ibuprofen.
In rare cases, cortisone injections may be used to try and control the pain. Cortisone is a very powerful steroid. However, cortisone is used very limitedly because it can negatively affect tendons and cartilage.
Surgical treatment
Patients who are helped by conventional means do not require surgery. Surgery may be recommended if the problem persists or if another pathology affects the shoulder joint.
For example, it is necessary to perform arthroscopic acromioplasty for impingement syndrome or arthrosis of the acromioclavicular joint, to perform surgery on the elements of the rotator cuff or articular lip.
Tenodesis of the biceps.
Biceps tenodesis is a method of reattaching the top of the tendon of the long head of the biceps to a new location, usually the front of the upper arm. Studies show that long-term results for patients with biceps tendonitis after this operation are not satisfactory. However, tenodesis may be necessary if the biceps tendons are already degenerative, which is common.
Rehabilitation
Rehabilitation after conservative treatment
You should be prepared to avoid stress on the arm for three to four weeks. As soon as the pain disappears, you need to gradually increase the load on the affected limb.
After consultation with the doctor, exercise therapy is prescribed individual program rehabilitation. The program usually takes four to six weeks. At first, all exercises are performed in the presence of an instructor. Initially, exercises are performed to maintain muscle tone and maintain range of motion in the shoulder and elbow joints provided that the inflammation is not increased. As soon as improvement occurs, connect special exercises to strengthen the biceps, as well as the muscles of the rotator cuff and the muscles of the scapula. At correct execution rehabilitation programs athletes can resume their training.
Rehabilitation after surgical treatment
Some surgeons prefer that their patients begin exercises as early as possible to increase range of motion in the shoulder and elbow joints. Initially, there will be a need to reduce pain and swelling. Cold or heat can be used locally for this, depending on the situation. If there are no contraindications, massage and various physiotherapy procedures can be used to reduce muscle spasms and pain. You need to be careful and gradually increase the complexity and number of exercises performed.
Heavy bicep exercises should be avoided for two to four weeks after surgery. From active exercise first, exercises with isometric muscle contraction are performed.
After two to four weeks, exercises with active muscle tension are performed. Initially, all exercises are performed under the supervision of an exercise therapy instructor. Gradually, the exercises are performed independently. As a rule, exercises are similar to activities performed in everyday life. An exercise therapy doctor will help you complete a rehabilitation course as soon as possible and as painlessly as possible.
We must be prepared for the fact that the treatment will take from six to eight weeks. Full recovery can take three to four months. Before the end of the course, ask how you can avoid shoulder problems in the future.