Anatomy TUESDAY – Stuff That Gets Pinched (Part 3) – Biceps Long Head Tendon

Good morning. It’s time to stretch. Reach your arms up overhead like you are trying to touch the ceiling. Do you feel a jam or pinch at the top of your shoulders? You shouldn’t. But if that is what you feel, chances are your biceps long head tendon is getting pinched.

There are two tendons that are prone to impingement in the shoulder: the supraspinatus and the biceps long head tendon. Look at the picture above. The biceps long head tendon (marked in red) runs in the bicipital groove of the humerus as it makes its way the the superior glenoid tubercle of the scapula (the top of the shoulder socket). Above it is the acromion (also part of the scapula).

When you lift your arms up overhead, the bicep tendon rides underneath the acromion. The picture above shows liberal amounts of space when in reality the subacromial space is only about 1 cm and narrows with arm elevation.

Chronic pinching of the biceps long head tendon in this space may result in tendonitis (tenosynovitis) and tears. How do you know if this is you? It hurts in your shoulder when you do this:

Why does this matter?

The subacromial space is not very forgiving. Any encroachment of that space will lead to chronic pinching of the biceps tendon and superior shoulder pain with arm elevation.

What causes this pinch?

An elevated or protracted scapula
Trigger points in the upper trapezius or infraspinatus (inferior angle)
Trigger points in pec minor
Trigger points in the biceps brachii muscle belly
Subluxation of medial clavicle at the SC joint

If you have this problem “unsticking” your scapula from your thorax will help “unpinch” your bicep. Try this exercise.

If you are a clinician treating a patient with this problem, assess and treat scapular and clavicular position and associated trigger points. Aim to clear the pinch in end range arm elevation to avoid biceps long head tenosynovitis and tears.

You should be able to reach up without feeling it at the top of your shoulder. Do the test.

Because nobody has time to be in pain.

Until next time…