The Incarcerating Biceps Tendon

Biceps incarceration is a dynamic entity resulting in impingement of the long head of the biceps tendon (LHBT) between the humeral head and the glenoid due to hypermobility of the tendon or proximal instability of the LHBT. It is a potential source of chronic pain with overhead motion. Physical examination includes the “3-Pack Exam,” with reproducible pain during the active compression test (O’Brien sign). Chronic abrasion and incarceration of the LHBT may result in medial biceps chondromalacia (BCM), an attritional lesion located at the anteromedial portion of the articular surface of the humeral head. The lesion may be evident on preoperative MRI or during arthroscopy and is confirmed with the arthroscopic active compression test. Treatment involves release of the intra-articular portion of the LHBT via tenotomy or soft tissue vs. bony tenodesis. This chapter will outline LHBT incarceration with discussion of relevant anatomy, clinical presentation, intraoperative findings, and surgical management.