Congenital absence of long head of the biceps tendon

Abstract

A 22-year-old male was referred to the shoulder surgeon with right shoulder pain after a forced adduction trauma of the upper extremity, and a missing biceps tendon on ultrasound. Previous medical history consisted of VATER association characterized by crossed ectopy of the left kidney, vertebral defects, pes equinovarus, and ventricular septum defect. Right renal dysplasia was treated with nefrectomy. Clinical examination of the shoulder showed evidence of sprain of the acromioclavicular joint. There was no “Popeye” sign to indicate a torn retracted biceps in the distal arm. On Magnetic Resonance Arthrography, absence of the tendon of the long head of the biceps and a shallow intertubercular groove was noted (Fig. A, black arrow on an axial image). In addition, there was no stump of the proximal biceps in the rotator cuff interval identified to suggest a torn and retracted biceps tendon (Fig. B, white arrows indicating the rotator cuff interval on a sagittal image). The short head of the biceps tendon was seen arising from the coracoid process, and there was a normal muscle bulk of the biceps brachii. The rotator cuff and labrum were normal. Subsequent Magnetic Resonance Imaging (MRI) of the elbow revealed a normal distal biceps tendon (Fig. C, black arrow on an axial T1-weighted image). Patient was treated conservatively including physiotherapy.