The intertubercular groove (bicipital groove) is the longitudinal channel between the greater and lesser tubercles of the proximal humerus through which the long head of the biceps tendon passes, held in place by the transverse humeral ligament. The floor of the groove receives the pectoralis major insertion (lateral lip), latissimus dorsi insertion (medial lip), and teres major insertion (medial lip below latissimus). The groove is approximately 5 cm long and its depth and angle vary considerably between individuals.
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| Ossification | Formed between the greater and lesser tubercles as their secondary centres ossify in early childhood; it lies on the upper metaphysis and proximal epiphysis of the humerus. |
The bicipital groove is the site of bicipital groove tendinitis and is the reference landmark for LHB impingement and dislocation. On ultrasound, the LHB is assessed in cross-section in the groove in the standardised anterior shoulder scanning position. In reverse total shoulder arthroplasty, the bicipital groove is the reference for component rotation. The groove angle and width affect LHB dislocation risk: shallow grooves predispose to medial LHB subluxation out of the groove.
With the arm by the side, elbow bent to 90 degrees, place your fingers on the front of the upper arm about 3-4 cm below the acromion. Slowly rotate the arm in and out; you will feel a vertical groove pass under your fingers between the greater tubercle (outer side) and the lesser tubercle (inner side). The long head of biceps tendon lies in the groove and may be tender.
Inflammation of the LHB tendon in its groove produces anterior shoulder pain at the bicipital groove, reproduced by Speed test and Yergason test, managed with physiotherapy, corticosteroid injection into the groove, or tenotomy/tenodesis for recalcitrant cases.
Disruption of the transverse humeral ligament and biceps pulley allows the LHB to displace medially from the groove, producing a palpable and occasionally audible click with shoulder rotation, requiring arthroscopic assessment of the pulley and tenodesis when symptomatic.
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