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.
| Origin | Supraspinatus tendon anterior margin and coracohumeral ligament |
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| Insertion | Subscapularis tendon superior margin |
| Actions | Maintains the biceps long head tendon within the bicipital groove; stabilises the anterior shoulder capsule |
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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.
Rotator interval sling tear allowing medial biceps long head tendon subluxation, producing anterior shoulder pain in throwers managed with arthroscopic repair or biceps tenodesis.
