Painful Biceps Vincula: An Unrecognized Cause of Anterior Shoulder Pain

Introduction: Vincula of the long head of the biceps tendon are an underrecognized entity. Very few studies have described the characteristics of symptomatic vincula following long head of biceps tendon auto-rupture or tenotomy. Materials and Methods: A retrospective case series was performed at a single institution. All patients who underwent shoulder arthroscopy and were noted to have a painful vinculum of the long head of the biceps tendon with partial or complete long head of the biceps tendon rupture between January 01, 2016, and December 31, 2020, were included. Patients were excluded if they underwent shoulder arthroplasty, open reduction internal fixation, or a glenohumeral joint stabilization procedure. Results: Eighteen consecutive patients with a long head of biceps tendon vincula noted during arthroscopy were identified. Ten patients were female (55%), with a mean age of 53 years (standard deviation SD 24.1). Of those with pre-operative magnetic resonance imaging available (n = 15), none reported the presence of a vinculum. Thirteen patients (72%) were found to have pathological vincula. Of these, seven patients were found to have a thickened vinculum tethering the long head of the biceps tendon. The most common reported pre-operative physical examination findings were bicipital tunnel tenderness to palpation (75%) and a positive O'Brien sign (50%). No patients experienced intraoperative or post-operative complications. Conclusion: The clinical significance of the long head of the biceps tendon vincula has not been previously described. In a subset of patients with anterior shoulder pain in the setting of long head of biceps tendon auto-rupture or prior tenotomy, a thickened long head of biceps tendon vincula can produce clinically significant symptoms of pain.