hourglass biceps

[Alexander Martinez]

I am interested in knowing if you have ever come across with the diagnosis of intra articular long head of the biceps tendinosis?,Can you make that diagnosis under ultrasound?
Do you use habermyer or modified habermyer classification for biceps subluxation and dislocation in your diagnosis of shoulder examination?

[Stephen Bird]

Absolutely, this is an important component of the ultrasound examination of the shoulder.
In my hands I can not diagnose SLAP labral lesions, but the biceps anchor is well seen.
I examine it in the short axis by following the biceps tendon proximally over the humeral head, you will observe the SGHL sitting beneath the medial edge of the tendon, then the SGHL moves into a position medial to the LHBT and the LHBT rests directly on the hyaline cartilage of the humeral head. At this point you are intra-articular. It is common to see tendinosis of this component of the biceps anchor while distally the biceps tendon is normal. Isolated biceps anchor tendinosis is a common diagnosis for me to make and is often seen in conjunction with a previous SST tear.
I also like to look at the thickness of the CHL and SGHL in this area as well as vascularity of these structures which will indicate either synovitis of the GH joint or adhesive capsulitis.
I do use the standard habermyer classification for LHBT subluxation. MRI is probably better but ultrasound is still very good at visualising these structures.
Others claim to have techniques for labral assessment, however personally I am not able to make progress with this.

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