Biceps Brachii

Authors
Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Figure 1: Muscles that move the Forearm
Reading list
  • Biceps brachii Muscle
  • Long head MMT
  • Short head MMT

Origin

The long head of the biceps inserts superiorly to the glenoid on:

  • Supraglenoid tubercle of scapula
  • Adjacent rim of Glenoid Labrum

The short head of the biceps inserts anterior to the glenoid on:

  • Coracoid process of Scapula
Figure 2: Left scapula (Posterior view)
Figure 3: Left Scapula (Lateral view)
Figure 4: Left Acromioclavicular and Glenohumeral joints (anterior view)

Insertion

Both heads of the biceps share a common insertion:

  • Radial tuberosity
  • Bicipital aponeurosis

Innervation

Musculocutaneous N. (C5, C6)

Action

  • Shoulder: Flexion
  • GHJ: Abduction, Internal rotation, Stabilization of humeral head during deltoid contraction
  • Elbow: Flexion; Supination

The biceps are most efficient at supination when the elbow is flexed to 90°.

Caution

Biceps contraction places the radius at an increased chance of anterior and proximal dislocation, but this is prevented due to the annular ligament.

Figure 5: Brachioradialis acting as a synergist for the Biceps Brachii
Note

The biceps brachii long head is also involved in abduction and a rupture will result in ~20% decrease in abduction strength.

Note

How does the Biceps Brachii Long head function as a GHJ stabilizer?

  • “Cadaver studies strongly suggest that the long head of the biceps restricts anterior translation of the humeral head”
  • “force generated in the muscle resists superior translation of the humeral head—an important force needed to control the natural arthrokinematics of abduction”
Note

“When the elbow is flexed, the biceps brachii acts as a powerful supinator because the lever arm is almost perpendicular to the axis of pronation/supination.”

Note

Note: When the elbow is flexed, the biceps brachii acts as a powerful supinator because the lever arm is almost perpendicular to the axis of pronation/supination.

Anatomy

  • Biceps Brachii Long Head tendon moves laterall from its origin, makes a right angle to place it in the anterior aspect of the humerus
    • This turn may cause abnormal wearing of the tendon

Tendon

The tendon of the Long Head of the Biceps Brachii “…crosses over the humeral head as it courses distally toward the intertubercular groove on the anterior humerus”

Clinical Relevance

The biceps may have a role in GHJ stabilization

Dysfunction

Biceps dysfunction is difficult to diagnose “One confounding factor is that there is no known pain pattern specific for the biceps tendon. Although biceps tendon pain can radiate down the front of the shoulder, pain into the front of the shoulder can be secondary to a variety of causes, including rotator cuff injury”

Palpation

Tenderness to Palpation

  • signs of biceps tendon injury.
  • Eliciting point tenderness by palpation of the biceps tendon in the biceps groove 3 to 6 cm below the anterior acromion with the arm in approximately 10° of internal rotation
  • area of point tenderness should move as the arm rotates internally and externall
  • Positive test: “pain elicited in the bicipital groove to deep pressure in the involved shoulder compared with no pain elicited with similar pressure to the bicipital groove of the opposite shoulder”
  • “Overall, tenderness on palpation had a sensitivity of 53%, a specificity of 54%, an accuracy of 54%, and a likelihood ratio of 1.13”

Tests

  • Speed’s Test
  • Palpation
  • Speeds + Biceps palpation
    • “If the patient had a positive Speed’s test and pain with biceps palpation, the combined positive tests yielded a sensitivity of 68%, a specificity of 49%, an accuracy of 59%, and a likelihood ratio of 1.31”

“Two commonly used techniques for making the diagnosis of biceps tendinitis are Speed’s test and palpation that elicits tenderness over the bicipital groove.”

Special Test

Speed’s Test

  • Patient standing with the elbow extended and the forearm in supination, the arm was elevated to 90° and extended slightly horizontally
  • Pt resists the downward force applied by the examiner
  • Positive: Pain was localized to the bicipital groove area in the anterior shoulder

Possible tests for biceps injury

“Only the lift-off test and the belly press test had a likelihood ratio of more than 2.0. These 2 tests had low sensitivities (0.28 and 0.17, respectively) but high specificity (0.89 and 0.92, respectively)”

Rehabilitation

Reading list
  • The Management of Biceps Pain: Non-Operative & Surgical

Strain-Counterstrain

Long head

“Location of Tender Point: Over the tendon of the long head of the biceps muscle, in the bicipital groove of the humerus. Anatomical Correlation: Long head of the biceps muscle. Direction to Press on Tender Point: Press from anterior to posterior. Treatment Position(s): With patient supine and the dorsum of the ipsilateral hand on the forehead, flex shoulder to about 90°. The elbow is also flexed. Fine-tune with either internal or external rotation. Frequency of Occurrence: Common to uncommon. Cereee Clinical Correlation(s): Pain in the anterior upper brachium and shoulder. Associated Pain Referral Pattern: Pain at times in the anterior elbow area. Alternate Names/Nomenclatures: None. Explanatory Notes: None.”

Short head

“SHORT HEAD OF THE BICEPS (SH) Location of Tender Point: On the inferior lateral aspect of the coracoid process. Anatomical Correlation: Short head of the biceps muscle. Direction to Press on Tender Point: Press from anterior lateral to posterior medial on the inferior lateral aspect of the coracoid process. Treatment Position(s): With patient supine, flex the shoulder to about 90° with the elbow also flexed. Moderate horizontal adduction. Frequency of Occurrence: Common to uncommon. Clinical Correlation(s): Pain in anterior upper brachium. Associated Pain Referral Pattern: |ntermittent pain in the anterior elbow area. Alternate Names/Nomenclatures: None. Explanatory Notes: None.”

References

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