Disorders of the long head of biceps tendon

Michael Khazzam, MDa,*, Michael S. George, MDb, R. Sean Churchill, MDc, John E. Kuhn, MDd

Disorders of the long head of the biceps (LHB) tendon can exist in conjunction with several other shoulder pathologies. Currently, the function of the LHB tendon remains unresolved. It is clear, however, that this tendon can be a significant source of shoulder pain and dysfunction. We have reviewed the anatomy, pathophysiology, classification, diagnosis, and treatment of disorders involving the LHB tendon. We also have reviewed the literature to help make treatment decisions.


The LHB tendon originates from the superior labrum and the supraglenoid tubercle. The exact location of labral attachment varies, but is usually in the posterior portion of the superior labrum.18,60

The intra-articular portion of the LHB tendon is partially stabilized by the biceps reflection pulley, which consists of the superior glenohumeral ligament (SGHL), the coracohumeral ligament, and deep fibers of the subscapularis and supraspinatus tendons64 (Fig. 1). The superior glenohumeral ligament runs spirally along the LHB tendon adjacent to the coracohumeral ligament3 (Fig. 2). The pulley stabilizes the LHB tendon as the tendon makes a 30° to 40° turn while exiting the glenohumeral joint.32 The LHB tendon travels deep to the coracohumeral ligament and through the rotator interval before exiting the glenohumeral joint.

Download the full article! »