Ultrasound-guided infiltration of the long head of the biceps

What is Ultrasound-Guided Infiltration of the Long Head of the Biceps?

Ultrasound-guided infiltration of the long head of the biceps is an interventional procedure that uses ultrasound guidance to deliver analgesic and anti-inflammatory medication into the tendon sheath of the long head of the biceps brachii in the shoulder. The goal is to reduce pain and inflammation in this tendinous structure.

The long head of the biceps brachii is a tendon that originates in the shoulder joint, runs along the front of the humeral head through a channel named after it, and is protected by a sheath. It is the proximal tendon of the biceps brachii muscle, and its pathology is a common cause of shoulder pain.

What are the indications for Ultrasound-Guided Infiltration of the Long Head of the Biceps?

Some of the indications for ultrasound-guided infiltration of the long head of the biceps include:

• Acute tendon and sheath inflammation: the tendon sheath is lined with a layer of synovial cells which, when affected by inflammatory processes, produce synovial fluid effusion. This is known as tenosynovitis of the long head of the biceps.
• Joint effusion: as this tendon is intra-articular, shoulder joint effusions can fill the tendon sheath of the long head of the biceps with joint fluid, mimicking an inflammatory process. The same ultrasound-guided approach can be used to evacuate this effusion.
• Tendon degeneration: also known as tendinopathy, a degenerative process of the tendon secondary to aging or overuse, which may cause pain and inflammation.
• Chronic tendon inflammation: secondary to rheumatic diseases.

What is the procedure for Ultrasound-Guided Infiltration of the Long Head of the Biceps?

Ultrasound-guided infiltration of the long head of the biceps is an outpatient procedure that takes approximately 10 minutes. The procedure includes the following steps:

• Preparation: the patient is positioned seated or lying down with the arm flexed at 90° and the limb externally rotated. The tendon is located using a prior ultrasound and the entry point is marked on the skin.
• Local anesthesia: in some cases, a small amount of local anesthetic may be applied to the skin to reduce pain sensation during the infiltration.
• Asepsis: an antiseptic is applied to the skin and the equipment and area are prepared under strict aseptic conditions.
• Ultrasound guidance: ultrasound is used to guide the needle toward the tendon sheath and ensure the medication is administered in the correct location.

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