Injuries of the Biceps Pulley System

Abstract

The biceps pulley system (BPS) consists of capsulo-ligamentous fibres that stabilize the long head of the biceps (LHB) before the tendon enters into the proximal segment of the bony bicipital groove. It is formed by conjoining parts of the superior glenohumeral ligament, the coraco-humeral ligament and supporting fibres from the subscapularis and supraspinatus tendons. Additionally, it creates the junction part of the biceps-labral complex. Numerous reasons like chronic degeneration, repetitive microtrauma as well as an acute trauma can result in a lesion of this anatomical structure. Injuries of the BPS lead to instability of the LHB and result in significant anterior shoulder pain. They are often associated with tears of the rotator cuff and biceps tendon, SLAP lesions or internal antero-superior impingement. Several classification systems describe different groups of pulley lesions depending on the anatomical structures that are involved. In rare cases conservative treatment may result in pain relief using anti-inflammatory medication and physiotherapy, but most of the lesions require proper surgical treatment. According to the literature, repair of the BPS is not an acceptable management choice. In addition to arthroscopic or open repair of the concerned structures, tenotomy and tenodesis of the LHB both seem to be consistent treatment options for most shoulder surgeons resulting in significant pain relief.