The proximal biceps long head tendon has a unique intra-articular course from the supraglenoid tubercle and superior labrum, through the shoulder joint inside a synovial sleeve, to the bicipital groove, making it susceptible to impingement and tenosynovitis. It is held in the groove by the biceps pulley (rotator interval sling) above and the transverse humeral ligament below. Proximal biceps tendon pathology is one of the most common causes of anterior shoulder pain, and tenodesis or tenotomy is a frequently performed procedure during rotator cuff repair.
| Muscle | |
|---|---|
| Attachment | Long head from the supraglenoid tubercle and superior glenoid labrum, travelling through the glenohumeral joint before entering the bicipital groove |
Bicipital groove pulley for the long head tendon; contributes to glenohumeral stability and depression of the humeral head
Speed's test (resisted shoulder flexion with the elbow extended and forearm supinated) and Yergason's test (resisted supination with the elbow flexed at 90 degrees) are specific for long head biceps pathology, and ultrasound assesses the tendon in the groove. SLAP tears involve the superior labrum at the biceps anchor and produce a snapping or clicking sensation during overhead activities. Pulley lesions or subscapularis tears allow the tendon to sublux medially out of the groove with a painful snap. Tenotomy gives rapid pain relief with little functional loss, while tenodesis (reattaching the tendon to the humerus below its groove) is preferred in younger, active patients to avoid a Popeye deformity.
Long head tendon degeneration within the bicipital groove producing anterior shoulder pain reproduced by Speed and Yergason tests, managed with physiotherapy and injection before biceps tenodesis or tenotomy.
Superior labral tear at the biceps anchor producing shoulder clicking and pain in overhead athletes, classified by Snyder and managed arthroscopically with repair or biceps tenodesis for symptomatic cases.
Complete tendon failure, usually in older patients with cuff disease, producing a Popeye deformity, often relief of chronic pain, and a modest loss of supination strength.
Medial displacement of the tendon from the groove after pulley or subscapularis injury, causing a painful snap with shoulder rotation.
