Long Head of Biceps Injection

Chronic tendinopathy

Causes and findings:
• Overuse
• Pain anterior top of humerus
• Painful: resisted elbow flexion with supination passive shoulder extension occasional arc on shoulder elevation

Equipment:
Syringe - 1ml
Needle - 23G 1-1.25 inches (25-30mm) blue
Kenalog 40 - 10 mg
Lidocaine - 0.75 ml 2%
Total volume - 1 ml

Anatomy:
The long head of biceps lies within a sheath in the bicipital groove between the greater and lesser tuberosities. It can be palpated by getting the patient to
contract the muscle under the palpating finger in the groove.

Technique:
• Patient sits with supported elbow held at right angle
• Identify tender area of tendon
• Insert needle perpendicular to skin at highest part of tenderness, then angle downwards parallel to tendon
• Inject solution as a bolus between tendon and sheath

Aftercare:
Advise relative rest for 1 week then address the causes of the lesion.

Comments:
This lesion is commonly diagnosed but, in our experience, is quite rare. Palpation of what is normally a tender area can lead to a misdiagnosis of this tendinopathy, when it might be pain referred from the cervical spine, shoulder joint or rotator cuff lesion. If there is a sudden onset of pain on flexing, a distinct bulge can appear mid-humerus, indicating rupture of the long head of biceps. After the pain has subsided the patient is usually able to function normally because the short head is sufficient to take over flexion activities.