Biceps Tendon Classifications

 LHB lesions: Topographical classification

Hedtmann, Verlag, 2002

  Lesions of LHB     I  SLAP lesions I-IV

Andrews lesions
 Supratubercular lesions     II  Isolated tendinosis / tendinitis
(Partial) tears of LHB

(Partial) tears of LHB in rotator cuff lesions

Supratubercular instability (Walch I)
 Sulcus associated lesions     III Subluxation / dislocation out of the bicipital groove (Walch II) without lesions of posterosuperior rotator cuff but where applicable accompanied with a lesion of the subscapularis tendon (and capsule)
 Lesions below the bicipital groove     IV

Peripheral of proximal LHB (e.g. at tendon-muscle transition zone)

 

Biceps tendon disorders: Yamaguchi and Bindra classification

In: Disorders of the Shoulder: Diagnosis and Management, Lippincott Williams and Wilkins, 1999

1. Inflammatory 

a. Biceps tendinitis with cuff disease
b. Primary biceps tendinitis

2. Instability

a. Subluxation- anterior
          unstable at proximal groove
          following mal/nonunion of lesser tuberosity
b. Dislocation- extraarticular with partial subscapularis tear
          intraarticular with full thickness subscapularis tear

3. Traumatic

a. Traumatic rupture- partial/ complete
b. SLAP lesions: Type 1- significant fraying
                         Type 2- complete detachment of biceps and labrum
                         Type 3- bucket handle tear of superior labrum
                         Type 4- central superior labral tear with biceps extension

Pulley lesions (Habermeyer 2004)

Habermeyer et al, JSES, 13:5-12, 2004

Group 1: isolated lesions of the SGHL

Group 2: lesion of the SGHL and partial articular side lesion of the supraspinatus tendon

Group 3: combination of a lesion of the SGHL and deep surface tear of   the subscapularis tendon

Group 4: combination of a lesion of the SGHL and a deep surface tear of the supraspinatus and subscapularis tendon

Histological changes in LHB tendon: Murthi

Murthi et al, JSES, 9:382-385, 2000

  1. Normal
  2. Chronic inflammation
  3. Fibrosis
  4. Mucinous degeneration
  5. Vascular congestion
  6. Dystrophic calcification
  7. Acute inflammation

Subluxation of long head of biceps: Habermeyer and Walch classification

In: Rotator cuff disorders, edited by Burkead, 142-159, Williams and Wilkins, 1996

Type I:  Superior subluxation with partial or complete tear of the rotator interval sling (the circular sling of the SGHL and coracohumeral ligaments).There may be an associated tear of supraspinatus.

Type II:  Subluxation at the groove. The tendon slips over the medial rim of the groove and sits upon the lesser tuberosity, with detachment of the superior portion of subscapularis.

Type III:  Malunion or non union of the lesser tuberosity

Dislocation of long head of biceps:  Habermeyer and Walch classification

Type 1

A. Extra-articular dislocation with a partial subscapularis tear

The biceps tendon is completely dislocated and lies over the lesser tuberosity. The deep part of subscapularis remains intact. The SGHL and coraco-humeral ligaments are detached.

B. Extra-articular dislocation with an intact subscapularis tendon

Type 2

Intra-articular dislocation of the long head of biceps combined with a complete tear of subscapularis tendon.

Biceps is widened and flattened. Subscapularis is completely torn from the lesser tuberosity ,biceps dislocates into the joint space infero-medially, associated with a cuff tear.