Biceps Pulley (Rotator Interval)

intervallum rotatorum

The biceps pulley is the soft tissue sling holding the biceps long head tendon in the bicipital groove, formed by contributions from the coracohumeral ligament, superior glenohumeral ligament, supraspinatus, and subscapularis at the rotator interval. Pulley tears allow the biceps tendon to sublux or dislocate medially out of the groove, producing medial biceps tendon instability that is a cause of anterior shoulder pain in overhead athletes.

Region: Shoulder

Anatomical Data

Origin, Insertion & Supply

Origin	Supraspinatus tendon anterior margin and coracohumeral ligament
Insertion	Subscapularis tendon superior margin

Biomechanics

Function & Actions

Actions	Maintains the biceps long head tendon within the bicipital groove; stabilises the anterior shoulder capsule

Clinical Relevance

Clinical Notes

Biceps pulley lesions are increasingly recognised as a cause of chronic anterior shoulder pain in throwing athletes and are classified by Habermeyer into four types based on which pulley components are torn. MRI arthrography best demonstrates the soft tissue lesion, and arthroscopic pulley repair or biceps tenodesis is performed for symptomatic instability.

Pathology

Common Injuries & Conditions

Biceps Pulley Lesion

Rotator interval sling tear allowing medial biceps long head tendon subluxation, producing anterior shoulder pain in throwers managed with arthroscopic repair or biceps tenodesis.