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Anomalous origin of the long head of biceps in a patient with anterior shoulder instability and long-term results of its repair

or clubbing. The patient had normal cardiovascular, abdominal, and respiratory examination and the vitals of patient were within normal limits. While on local examination, there was no atrophy noted in the upper extremity or about the shoulder. There was a full symmetric range of motion of both the upper extremities. Strength was normal bilaterally, especially resisted shoulder abduction and external rotation, as well as, elbow flexion and supination. The apprehension test was positive for both pain and apprehension. The internal impingement test was negative. Both the O’Brien test and the Speed test were negative. There was no sign of ligamentous laxity. Magnetic resonance imaging of the right shoulder was performed which showed a soft-tissue Bankart lesion with Hill-Sachs lesion and no other lesion was seen. Arthroscopic examination performed in the lateral arthroscopy position showed the anomalous origin of the long head of biceps over the supraspinatus tendon (Fig. 1). The patient had a Bankart lesion and a non-engaging Hill-Sachs lesion appreciable on dynamic testing, that is, on releasing lateral traction and taking the limb in abduction and external rotation. ABSTRACT The long head of the biceps tendon normally originates from the superior glenoid tubercle. There have been several descriptions of anomalous origins of the tendon of the biceps, but their clinical implications remain mostly unknown. They are mostly incidental findings during arthroscopic surgery and include aberrant origins and agenesis. Due to the rare nature of these lesions, it is unlikely that substantial sample size will be generated in the future to propose treatment recommendations. Nevertheless, shoulder arthroscopy surgeons should be aware of its potential to become pathologic and causing shoulder dysfunction. We are presenting a case of a young sportsperson who presented to us with a complaint of anterior instability and its long-term follow-up after repair. The anomalous origin of the biceps tendon was noted incidentally on arthroscopy while doing the repair though the patient did not report any pain due to the same both preoperatively and after surgery.