Aberrant origin of the long head of the biceps: a case series

Variants of the origin of the long head of the biceps have been described intraoperatively. It is unclear whether these variants contribute to shoulder pathology. Our purpose was to describe an anatomic variation of the origin of the long head of the biceps and associated clinical presentations of 2 subjects and to review existing reports of other variants.

We present the history and physical examination, imaging, and arthroscopic findings of 2 cases of an abnormal variant of the origin of the long head of the biceps.

In 2 subjects, the long head of the biceps was noted to have a Y-shaped origin with 1 limb coming from the rotator cable and the other limb taking origin medial to the superior glenoid tubercle. A 42-year-old male weightlifter presented with distal clavicle osteolysis confirmed by diagnostic injection and had resolution of symptoms after a distal clavicle excision. A 38-year-old female retired military officer presented with subcoracoid impingement confirmed by magnetic resonance imaging findings and a diagnostic injection and did well after subcoracoid decompression. In neither case did the biceps tendon appear diseased or related to shoulder pathology.

In rare cases, the long head of the biceps takes origin from the rotator cable and has a second origin medial to the supraglenoid tubercle. This variant does not appear to contribute to shoulder pathology because standard treatment of concomitant diagnoses resulted in resolution of symptoms.