Biceps (long head) !

The long head of the biceps is the outer part of the biceps, starting inside the shoulder joint; it bends the elbow and turns the palm up.

Official name: Biceps brachii, long head

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What it is

The outer head of the biceps; when its tendon ruptures at the shoulder the muscle bunches into a 'Popeye' bulge.

What it does

Bends the elbow and turns the palm up.

Key facts

Origin: Supraglenoid tubercle
Insertion: Radial tuberosity and bicipital aponeurosis
Action: Supinates the forearm, flexes the elbow, weakly flexes the shoulder
Nerve: Musculocutaneous nerve (C5–C6)
Blood supply: Brachial artery

Relations

Course: From the supraglenoid tubercle and superior labrum over the humeral head inside the capsule, through the rotator interval, down the intertubercular groove, then joins the short head in the lower arm
Superficial: Front deltoid; the pectoralis major tendon crosses in front of the groove
Deep: Humeral head, then the humerus and the brachialis
Medial: Biceps (short head) and coracobrachialis

How to find it

The long biceps tendon is felt in the intertubercular groove on the front of the shoulder, just lateral to the coracoid and below the acromion; with the elbow bent, it rolls under the fingers as the arm is turned in and out.

Examination

Biceps reflex (thumb on the tendon at the elbow, tapped): a reduced reflex points to the C5–C6 root or the musculocutaneous nerve; a brisk one with other signs suggests an upper motor neuron lesion
O'Brien active compression test: arm forward at 90°, slightly across the body, thumb down, resisting; deep pain that eases with the palm up suggests a SLAP lesion, pain on top of the shoulder an AC joint problem

On imaging

On ultrasound, short-axis views show the tendon in its groove; an empty groove means rupture or dislocation. Fluid around it is often joint fluid, since the sheath connects with the joint. MR arthrography is used for SLAP tears.

Common problems

Tendinitis in its groove, with pain at the front of the shoulder.
SLAP tear where it anchors to the top of the labrum.
Rupture, usually in older adults with cuff wear: a 'Popeye' bulge in the arm, often with little lasting weakness.
Slipping out of its groove (subluxation) with subscapularis tears.

How it is diagnosed

Tenderness in the groove and special tests (Speed's, Yergason's). Ultrasound or MRI.

Treatment

Rest, anti-inflammatory medicines, physical therapy and sometimes an ultrasound-guided injection.
Biceps tenodesis (re-attaching the tendon lower on the humerus) or tenotomy (releasing it).
SLAP repair in selected young athletes.

Clinical notes

Chronic pain from the long head is treated by tenotomy (simple, may leave a 'Popeye' bulge and cramps) or tenodesis (the tendon fixed in or below the groove)
It is the first landmark seen at shoulder arthroscopy, where its anchor on the superior labrum is checked

Anatomical variants

Variation in where the heads arise is common (about a third on the cited page)
Extra (supernumerary) heads are seen in a few percent (2–5% on the cited page; some series report more)

Test yourself

Think of the answer, then tap the question to see it.

What is the course of the tendon of the long head of biceps at the shoulder?

From the supraglenoid tubercle and superior labrum, over the humeral head inside the capsule but outside the synovium, through the rotator interval and down the intertubercular groove.

What keeps the long biceps tendon in its groove?

A pulley of coracohumeral ligament, superior glenohumeral ligament and subscapularis fibres; damage to it lets the tendon slip medially.

Which roots and nerve does the biceps reflex test?

C5–C6 through the musculocutaneous nerve.

What does the O'Brien active compression test suggest?

Arm forward at 90°, slightly across the body, thumb down, resisting: deep pain easing with the palm up suggests a SLAP lesion; pain on top, an AC joint problem.

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2): caput longum musculi bicipitis brachii TA2 2465
Official Spanish (DeCS): Cabeza larga del músculo bíceps braquial
English (TA2): Biceps brachii, long head

Sources: Terminologia Anatomica (TA2); Anatomy, Shoulder and Upper Limb, Biceps Muscle.

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Representative model, for educational purposes only.