Clinical relevance of the anatomy of the long head bicipital groove, an evidence-based review.

INTRODUCTION: Pathology in the bicipital groove can be a source of anterior shoulder pain. Many studies have compared treatment techniques for the long head biceps tendon (LHBT) without showing any clinically significant differences. As the LHBT is closely related to the bicipital groove, anatomical aspects of this groove could also be implicated in surgical outcomes. The aim of this review is to contribute to developing the optimal surgical treatment of LHBT pathology based on clinically relevant aspects of the bicipital groove. METHODS: Medline/PubMed was systematically searched using key words "bicipital" and "groove" and combinations of their synonyms. Studies reporting on evolution, embryonic development, morphometry, vascularization, innervation and surgical treatment of the LHBT and the bicipital groove were included. RESULTS: The length of the bicipital groove reported in the included studies ranged from 81.00 mm to 87.33 mm, width from 7.74 mm to 11.60 mm and depth from 3.70 mm to 6.00 mm. Quality assessment of cadaveric studies showed a lack of reporting sample information, investigator education and number of observers. The anatomy of the bicipital groove shows a bottleneck narrowing approximately two-thirds from superior. The transverse humeral ligament can constrain the bicipital groove and could be involved in anterior shoulder pain. CONCLUSION: When either LHBT tenotomy or tenodesis is performed, routinely releasing the transverse ligament could decrease postoperative anterior shoulder pain, which has frequently been reported in the literature. To avoid narrowing the bottleneck, a location below the bicipital groove should be preferred over a more proximal tenodesis site for biceps tenodesis. This article is protected by copyright. All rights reserved.