The proximal biceps long head tendon has a unique intra-articular course from the supraglenoid tubercle through the shoulder joint to the bicipital groove, making it susceptible to impingement and tenosynovitis within the groove. It is stabilised in the groove by the biceps pulley (rotator interval sling). Proximal biceps tendon pathology is one of the most common causes of anterior shoulder pain, and tenodesis or tenotomy of the proximal tendon is a frequently performed procedure during rotator cuff repair.
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. SLAP tears involve the superior labrum at the biceps anchor and produce a snapping or clicking sensation during overhead activities. Proximal biceps tenodesis (reattaching the tendon to the proximal humerus below its groove) eliminates groove pain while preserving biceps function.
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.
