Biceps brachii

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A Moment in History

William S. Halsted, MD
(1852 – 1922)

American anatomist, teacher, and surgeon, William Stewart Halsted was born in New York City, USA to a wealthy family of English origin. His father was involved in charitable work and Governor and trustee to a city hospital. Not a brilliant student initially, Halsted took an undergraduate in Liberal Arts in Yale, CT., after which he entered the Medical College of Physicians at the Columbia College, where he excelled.

As a second-year medical student Halsted applied and obtained a position in surgery at a local hospital. In here he learned about Lister’s antiseptic technique and became an adamant proponent of it to reduce infection. In 1877 Halsted obtained his MD. After a short time as House Physician at the New York Hospital, Halsted traveled to Europe to further his education studying for two years at the Universities of Vienna, Leipzig, and W?rzburg.

Besides being at the forefront of surgical and antiseptic techniques (introducing the use of rubber gloves in surgery), Halsted was extremely concerned with the way medical students were taught in the US. He pioneered bedside clinical round discussions with the medical students after two years of basic sciences studies. Halsted developed the idea of a patient chart; he also developed the residency program for medical students in use today.

Halsted is probably the most influential researcher and surgeon at the turn of the century. He dedicated time to the study of intestinal anastomoses and the use of silk as a suture material. His experimental work in 1887 proved that the inclusion of the submucosa layer in an anastomosis was mandatory, as well that a single layered anastomosis was enough to attain closure. Perhaps Halsted’s most important contribution was the application and use of the scientific method to surgical questions. Halsted’s principles set the standards used today in surgical suturing and surgical stapling.

He also pioneered the development and surgical techniques for radical mastectomy as a treatment for breast cancer.

As a side effect of this studied in anesthesia and the use of cocaine for anesthesia, Halsted became addicted to this substance, a problem that followed him through the years. Without impairing his capacity as a researcher and a surgeon, Halsted eventually recovered. He died in Baltimore in 1922 as a complication to surgery.

Sources:
1. Dubay, A. D., & Franz, G. M. (2003). Acute Wound Healing: The Biology of Acute Wound Failure. Surg Clin NA, 83, 463-481.
2. Halsted, W. S. (1887). Circular Suture of the Intestine - An Experimental Study. Am J Med Sci, 436-461.
3. “William Stewart Halsted: his life and contributions to surgery” Osborne, P. Lancet Oncol 2007; 8: 256–65
4. “William Stewart Halsted: Surgical pioneer” Burress, P Endoc Today (2010), 8: (2) 22
5. “William Stewart Halsted (1852–1922) Neurological stamp” Haas, LF J Neurol Neurosurg Psych 2000;69:641
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Details: Published: November 01, 2022

Biceps brachii muscle.
Click on the image for a larger depiction

The musculus biceps brachii is a long muscle found in the anterior, aspect of the arm and is one of the three muscles contained in the anterior compartment (flexor compartment) of the arm, the other two being the brachialis and coracobrachialis muscles. It is composed by two muscular heads, one long (lateral) , and one short (medial) that originate superiorly from separate tendons that attach to the scapula. These two heads join to form a single long, oval-shaped belly with a single tendon that crosses the elbow joint and attaches to the radius.

The short tendon of the biceps brachii passes anteromedial to the shoulder joint and attaches to the coracoid process of the scapula by way of a tendon that mixes with the tendon of the coracobrachialis muscle.

The long cylindrical tendon of the biceps brachii is found in the intertubercular (bicipital) groove (Lat: sulcus intertubercularis) of the humerus, and passes between the greater and lesser tubercles of the humerus, entering the articular cavity of shoulder joint, and continues superiorly to insert in the supraglenoid tubercle of the scapula.

The distal, common tendon of the biceps brachii courses inferiorly and attaches to the radial (bicipital) tuberosity of the radius. There is a well-defined bursa between the radial tuberosity and the biceps brachii tendon that allows for movement of the tendon.

Also, a flat, fascial extension of the tendon, known as the bicipital aponeurosis extends inferomedially to blend with the antebrachial aponeurosis that covers the epitrochlear muscles of the forearm (pronator teres, flexor carpi radialis muscles). The brachial artery passes between the tendon of the biceps brachii and the bicipital aponeurosis in the anterior aspect of the elbow joint.

The biceps brachii crosses both the shoulder and the elbow join. As such, its functions will depend on which joint is fixed and which one is not. This muscle flexes the elbow, supinates the forearm, and flexes the shoulder.

It is innervated by the musculocutaneous nerve (C5,D6) which is a branch of the brachial plexus. It receives arterial supply by way of muscular branches that arise from the brachial artery.

The name of the muscle literally means "two heads" as the prefix "bi" means "two" and the Latin term "-ceps" means "head".

Note: Because the long and the short head of the biceps brachii attach to different locations of the scapula, some authors and Internet websites say that there are 18 muscles that attach to the scapula. I do not agree, as the biceps brachii is a single muscle that happens to have to separate attachments to the scapula. It would be different if this article was titled "Name the 18 separate muscular attachment points of the scapula". Dr. Miranda

The image is modified from the original via Wikimedia. Public domain. Animated image below by Wikimedia Commons - Anatomography [CC BY-SA 2.1 following Creative Commons attributes.

Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 42nd British Ed. Churchill Livingstone 2021
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015
5. "Trail Guide to The Body" 4th. Ed. Biel, A. Books of Discovery. 2010

Biceps brachii

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