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# Biceps tendon sheath

The biceps tendon sheath lines the long biceps tendon in its groove on the [humerus](https://durgical.com/en/anatomy/humerus/); it is an extension of the shoulder joint lining.

Official name: Intertubercular (biceps) tendon sheath

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## What it is

The sleeve around the long biceps tendon in its groove.

## What it does

Lets the tendon glide; it is continuous with the shoulder joint.

## Key points

- It is an extension of the shoulder joint's synovium, so fluid in the sheath often reflects a joint effusion rather than primary tenosynovitis
- Bicipital tenosynovitis gives anterior shoulder pain with a tender spot that moves with the groove as the arm rotates
- The long biceps tendon dislocates medially out of the groove when the subscapularis tendon is torn

## Key facts

**Where**
Intertubercular groove, under the transverse humeral ligament

**Function**
Synovial sleeve continuous with the shoulder joint around the long head of biceps

## Relations

**Contents**
[Long biceps tendon](https://durgical.com/en/anatomy/tendon-of-the-long-head-of-biceps/)

**Superficial**
[Transverse humeral ligament](https://durgical.com/en/anatomy/transverse-humeral-ligament/) bridging the groove; below it, the [pectoralis major tendon](https://durgical.com/en/anatomy/pectoralis-major-tendon/) on the lateral lip; the anterior deltoid over all

**Medial**
Lesser tuberosity with the [subscapularis tendon](https://durgical.com/en/anatomy/subscapularis-tendon/)

**Lateral**
Greater tuberosity

**Deep**
Floor of the intertubercular groove, where the [latissimus dorsi](https://durgical.com/en/anatomy/latissimus-dorsi-muscle/) tendon inserts

## How to find it

With the arm at the side and the elbow bent at 90°, the groove is felt on the front of the humeral head under the anterior deltoid; turning the arm in and out rolls the groove, and any tender spot, under the finger.

## Examination

- Speed test: pain in the groove on resisted forward elevation with the elbow straight and palm up suggests biceps tendinopathy
- Yergason test: pain in the groove on resisted supination with the elbow bent; a palpable snap suggests tendon instability

## On imaging

The short- [axis](https://durgical.com/en/anatomy/axis/) ultrasound view shows the tendon centred in the groove; an empty groove means dislocation or rupture. Fluid around the tendon is read together with fluid in the joint.

## Clinical notes

- Rupture of the long head gives a Popeye bulge low in the arm, usually in older people with rotator cuff disease, with little loss of strength
- Tenotomy or tenodesis of the long head treats painful tendinopathy and SLAP lesions

## Memory aid

Lady between two majors: latissimus dorsi in the floor of the groove, [pectoralis major](https://durgical.com/en/anatomy/pectoralis-major-muscle/) on its lateral lip, [teres major](https://durgical.com/en/anatomy/teres-major/) on its medial lip.

## Related conditions

- [Biceps tendon rupture](https://durgical.com/en/conditions/biceps-tendon-rupture/)

## Test yourself

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

## Why does fluid in the biceps tendon sheath often reflect a shoulder effusion?

The sheath is an extension of the shoulder joint's synovium, so joint fluid tracks into it.

## What do the Speed and Yergason tests assess in the biceps tendon sheath?

Speed: pain in the groove on resisted forward elevation, elbow straight, palm up (tendinopathy). Yergason: pain on resisted supination, elbow bent; a snap suggests instability.

## When does the long biceps tendon dislocate out of its sheath, and in which direction?

Medially, out of the intertubercular groove, when the subscapularis tendon is torn.

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

## Its names

**Official Latin (TA2)**
vagina tendinis intertubercularis TA2 2570

**Official Spanish (DeCS)**
Vaina tendinosa intertubercular

**English (TA2)**
Intertubercular (biceps) tendon sheath

## Related

- [Long biceps tendon](https://durgical.com/en/anatomy/tendon-of-the-long-head-of-biceps/)
- [Humerus](https://durgical.com/en/anatomy/humerus/)

Sources: Terminologia Anatomica (TA2); [Anatomy, Shoulder and Upper Limb, Biceps Muscle](https://www.ncbi.nlm.nih.gov/books/NBK519538/).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anatomy/intertubercular-tendon-sheath/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/intertubercular-tendon-sheath/