Meyer, Arch Surg 1921 - Unrecognized Occupational Destruction of the Tendon of the Long Head of the Biceps Brachii

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Unrecognized Occupational Destruction of the Tendon of the Long Head of the Biceps Brachii

Meyer·Arch Surg·1921·50 citations·Anatomic study

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A 1915 cadaveric anatomical study by Meyer describing 13 shoulders with progressive destruction of the long head of biceps tendon, building on his original 1915 report of 6 cases. The paper asks what causes this destruction and proposes an occupational mechanical friction mechanism originating at the subacromial space.

Key Findings

Among roughly 60 cadavers dissected after the original report, 13 shoulders showed LHB tendon destruction — Meyer calls this "rather common," an unexpectedly high prevalence from a single anatomic laboratory
Destruction followed a consistent anatomic sequence, progressing in stages rather than beginning at the tendon itself:
- Acromial soft-tissue fraying and capsular thickening at the inferior surface
- Superior capsular breach near the greater tuberosity from repetitive impingement
- Direct friction-mediated tendon abrasion once roughened bone contacted the intracapsular tendon
- Articular cartilage remained grossly intact even at intermediate stages of tendon loss
In every case of complete intracapsular tendon loss, the stump anchored distally just below the lesser tuberosity rather than retracting freely — held by local inflammatory periosteal reaction, making that anchor site itself a potential pain source
5 of the original 6 cases with complete tendon destruction also showed damage to the capsule, acromion, tuberosities, glenoid, humeral head, acromioclavicular joint, and deltoid — confirming that advanced biceps pathology is rarely an isolated finding
Meyer explicitly rejects infection and primary arthritis as causes — normal spongiosa in all bisected humeri and intact cartilage amid severe tendon loss — attributing destruction instead to repetitive occupational abduction and external rotation

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|

Unrecognized Occupational Destruction of the Tendon of the Long Head of the Biceps Brachii

Meyer·Arch Surg·1921·50 citations·Anatomic study

Free Full Text·DOI

|

A 1915 cadaveric anatomical study by Meyer describing 13 shoulders with progressive destruction of the long head of biceps tendon, building on his original 1915 report of 6 cases. The paper asks what causes this destruction and proposes an occupational mechanical friction mechanism originating at the subacromial space.

Key Findings

Among roughly 60 cadavers dissected after the original report, 13 shoulders showed LHB tendon destruction — Meyer calls this "rather common," an unexpectedly high prevalence from a single anatomic laboratory
Destruction followed a consistent anatomic sequence, progressing in stages rather than beginning at the tendon itself:
- Acromial soft-tissue fraying and capsular thickening at the inferior surface
- Superior capsular breach near the greater tuberosity from repetitive impingement
- Direct friction-mediated tendon abrasion once roughened bone contacted the intracapsular tendon
- Articular cartilage remained grossly intact even at intermediate stages of tendon loss
In every case of complete intracapsular tendon loss, the stump anchored distally just below the lesser tuberosity rather than retracting freely — held by local inflammatory periosteal reaction, making that anchor site itself a potential pain source
5 of the original 6 cases with complete tendon destruction also showed damage to the capsule, acromion, tuberosities, glenoid, humeral head, acromioclavicular joint, and deltoid — confirming that advanced biceps pathology is rarely an isolated finding
Meyer explicitly rejects infection and primary arthritis as causes — normal spongiosa in all bisected humeri and intact cartilage amid severe tendon loss — attributing destruction instead to repetitive occupational abduction and external rotation

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