Clinical History
71 year old female with painful clicking of the anterior shoulder.
Diagnosis: Dislocating Long Head Biceps Tendon of the Shoulder
The long head biceps tendon normally courses within its tendon sheath in an osseous groove of the anterior humerus called the bicipital groove, kept in place by the transverse humeral ligament that forms the roof for the bicipital groove.
The long head biceps tendon is a common source of anterior shoulder pain; tendinosis, tenosynovitis, and tears can all be a cause of pain.
If the transverse humeral ligament is disrupted, the long head biceps tendon can become unstable and can sublux or dislocate out of the bicipital groove with shoulder motion.
Ultrasound is an ideal modality for assessing the long head biceps tendon.
Tendinosis, tenosynovitis, and tears of the tendon can be diagnosed on ultrasound, and the ability to perform a dynamic evaluation also allows ultrasound to diagnose conditions that are only seen with certain shoulder positions or motions, such as dislocation of the biceps.
Ultrasound also allows the radiologist to confidently attribute the tendon dislocation to the clicking felt by the patient and to assess whether it is the source of pain.