The transverse humeral ligament spans the bicipital groove, converting it from an open groove into a fibro-osseous tunnel that retains the long head of biceps tendon. It blends with the subscapularis and supraspinatus insertions and acts as a pulley for the biceps tendon.
Transverse humeral ligament tears allow medial subluxation of the biceps tendon from the groove, producing a palpable and audible snap with shoulder internal rotation. Ultrasound with dynamic rotation confirms tendon subluxation. Surgical reconstruction of the ligament or biceps tenodesis at the groove addresses this instability. The ligament integrity determines whether biceps tenodesis or tenotomy is appropriate.
Medial subluxation of the LHB from the bicipital groove from transverse ligament disruption producing a painful snap with shoulder rotation, treated by surgical ligament repair or biceps tenodesis.
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