The long head of biceps tendon arises from the supraglenoid tubercle and superior glenoid labrum, traversing the glenohumeral joint intra-articularly before entering the bicipital groove. It is stabilised in the groove by the transverse humeral ligament and the comma tissue. The intra-articular portion is 3-4 cm long and surrounded by a synovial sleeve continuous with the joint.
The long head of biceps tendon is one of the most common sources of anterior shoulder pain. Pathology ranges from tendinopathy within the groove to superior labral tears (SLAP) at the origin, to rupture causing the Popeye deformity. The Speed and Yergason tests assess tendon integrity. Biceps tenodesis (groove fixation) or tenotomy (with release) are the two surgical options, with tenodesis preferred in active patients under 60.
Degenerative change in the intragroove tendon producing anterior shoulder pain reproduced by Speed test and direct groove palpation.
Complete tendon failure at the groove or supraglenoid origin producing a Popeye deformity, relief of chronic pain, and 10-15% loss of supination strength.
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