Shoulder symptoms and biceps variants in overhead athletes

Throwing athletes often present a painful shoulder due to several possible causes, including superior labrum anterior to posterior (SLAP) tears, biceps pathology, partial thickness rotator cuff tears, “internal impingement” with an excessive external rotation and a Gleno-humeral Internal Rotation Deficit (GIRD) and a postero-inferior capsular contracture. A narrative review about shoulder pathology in overhead athletes and long head of the biceps (LHB) variants was performed and a case report of a tennis player with a biceps variant is presented. The tennis player recovered the full range of motion of the shoulder after releasing the limb of the LHB. This case highlights that a cause of pain and dysfunction in the tennis player can be associated to the anatomical variant of the LHB origin. The SPL-DO variant seemed to restrict the shoulder internal rotation in this throwing active patient. LHB anatomical variants should therefore be considered and treated in some overhead athletes, when identified and related to a significant clinical condition. This case represents the first demonstration of the efficacy of releasing the limb of the LHB connected to the cuff, to regain the passive internal rotation.