The long head has the longest course of any upper arm tendon, traversing the glenohumeral joint intra-articularly before entering the bicipital groove. This anatomy makes it vulnerable to both proximal (SLAP, tendinopathy) and distal (groove exit rupture) pathology.
| Origin | Supraglenoid tubercle and superior glenoid labrum (intra-articular) |
|---|---|
| Insertion | Radial tuberosity and bicipital aponeurosis |
| Nerve Supply | Musculocutaneous nerve (C5, C6) |
| Blood Supply | Brachial artery; Anterior circumflex humeral artery (proximal tendon in the bicipital groove) |
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It flexes the elbow and supinates the forearm, and at the shoulder it assists flexion and helps stabilise the humeral head in the glenoid.
The proximal long head tendon is a common source of anterior shoulder pain: SLAP tears at the biceps anchor on the superior labrum, tenosynovitis in the bicipital groove and medial subluxation of the tendon with subscapularis tears. O'Brien active compression and Speed tests help assess these, and chronic groove pain is reliably treated by biceps tenodesis or tenotomy. Proximal rupture, usually at the groove in older people, produces the Popeye deformity from distal bunching of the muscle belly, and repair is optional, mainly for cosmesis or heavy manual work. Distal biceps tendon rupture is a separate injury causing significant supination weakness and is usually repaired promptly.
Palpable throughout the anterior arm. The long head forms the lateral biceps groove.
Spontaneous rupture at the bicipital groove producing the Popeye sign, treated conservatively in older patients or by tenodesis in active individuals.
A tear of the superior labrum at the biceps anchor, common in throwing athletes, causes deep shoulder pain and catching with overhead activity; it is treated with rehabilitation, SLAP repair or biceps tenodesis.
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