Ultrasound-guided infiltration of the long head of the biceps

The long head of the biceps brachii is a tendon that originates in the shoulder joint, runs along the anterior surface of the humeral head through a canal that bears its name, 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. Ultrasound-guided injection of the long head of the biceps is an ultrasound-guided procedure aimed at improving pain and inflammation in this tendon structure through the injection of medication at the level of the tendon sheath.

Ultrasound-guided injection of the long head of the biceps is performed on an outpatient basis and lasts approximately 10 minutes. The procedure is as follows:

• Preparation: The patient is positioned lying down with the arm flexed 90° and the limb externally rotated. The tendon is located with a prior ultrasound, and the entry site is marked on the skin. Local anesthesia: A small amount of local anesthesia may sometimes be applied to the skin to reduce pain during the injection.
• Asepsis: An antiseptic is applied to the skin, and the equipment and the field are prepared under strict aseptic conditions.
• Ultrasound guidance: Ultrasound is used to guide the needle into the tendon sheath and ensure the medication is administered at the correct site.

Some of the indications for ultrasound-guided injections of the long head of the biceps are:

• Acute inflammation of the tendon and its sheath: The tendon sheath is covered by a layer of synovial cells that, when affected by inflammatory processes, cause synovial fluid leakage. This is called tenosynovitis of the long head of the biceps (a very common diagnosis in ultrasound and MRI reports).
• Joint effusion: Since it is an intra-articular tendon, effusions in the shoulder joint can fill the tendon sheath of the long head of the biceps with joint fluid and mimic an inflammatory process. The same ultrasound-guided injection approach can be used to evacuate this effusion.
• Tendon wear: Also known as tendinopathy, a degenerative process of the tendon secondary to aging or overuse that can cause pain and inflammation.
• Chronic tendon inflammation: secondary to rheumatic diseases.