Clinical Anatomy, Biomechanics, Physiologic Function, History, Examination, and Radiographic Evaluation of the Biceps

The proximal biceps tendon is a unique structure that can be a pain generator frustrating for both patient and clinician. Its anatomic position in close relation to other critical structures of the joint, such as the RC, makes it prone for biomechanical stresses, as well as difficult to isolate as a sole cause of shoulder pain and dysfunction. The tendon originates with variable fiber insertions from the glenoid labrum and supraglenoid tubercle with slight anatomic variations. Before entering the intertubercular groove, the tendon is guided by the structures of the “pulley” system, which include the tendon of the supraspinatus and subscapularis muscle. Therefore, lesions of the long head of the biceps tendon are often combined with other significant pathologies of the glenohumeral joint. The function of the long head of the biceps tendon may be more of a proprioceptive one, although significant stress may arise when the rotator cuff is insufficient. An accurate history and complete physical examination are critical to find the exact diagnosis and initiate the correct treatment.