Arthrographic Anatomy of the Biceps Tendon Sheath: Potential Implications for Selective Injection

The purpose of this investigation was to better define the anatomical features of the biceps tendon sheath, including the distance the sheath extends below the inferior margin of the subscapularis tendon and below the termination of the bony bicipital groove. A total of 110 magnetic resonance and computed tomography arthrograms performed during 1-year period at our institution were retrospectively reviewed, and the length of the biceps tendon sheath and distances from the inferior margin of the subscapularis tendon and from the termination of the bicipital groove to the inferior margin of the biceps tendon sheath were measured by 3 radiologists. The mean length of the biceps tendon sheath was 47.5 mm. The mean distances from the inferior margin of the subscapularis tendon and from the inferior margin of the bicipital groove to the distal extent of the biceps tendon sheath were 24.5 mm and 11.9 mm, respectively. The relationships among these 3 anatomical measurements and biological confounders of sex and age were investigated while controlling for measurement variability. The anatomical relationships between the biceps tendon sheath and surrounding structures may have implications for needle placement when attempting to inject into the biceps tendon sheath for diagnostic or therapeutic purposes.