Proximal Biceps Long Head: Anatomy, Biomechanics, Pathology

The intra-articular course of the long head of the biceps tendon (LHBT) through the glenohumeral joint is a special anatomical feature. It originates at the supraglenoid tubercle with fibers deriving directly from the glenoid labrum and is stabilized by a pulley complex at the entrance into the bicipital groove. The LHBT is biomechanically important for the glenohumeral joint and is considered as dynamic stabilizer that acts in synergy with other structures like the rotator cuff. The characteristic anterior shoulder pain of LHBT pathology can be caused by chronic inflammation, ruptures, instability, or by a combination of these. Due to its anatomical and biomechanical interaction with other structures, isolated lesions of the LHBT are extremely rare. Rotator cuff tears are highly associated with pathology of the LHBT. The complexity of LHBT lesions represents a major challenge for the clinician regarding both diagnosis and treatment.