Long biceps tendon !

The long biceps tendon runs from the top of the shoulder socket down a groove in the humerus; it links the biceps to the shoulder.

Official name: Tendon of the long head of biceps

See in 3D →

Opens in the Durgical app, no sign-up needed.

What it is

The long, thin tendon that runs from the top of the socket over the ball and down the groove of the humerus.

What it does

Connects the biceps to the shoulder and helps press the ball into the socket.

Key facts

Attaches: Supraglenoid tubercle and superior labrum, across the shoulder joint (inside the capsule, outside the synovium) and down the intertubercular groove under the transverse humeral ligament
Function: Links the long head to its belly; tendinopathy, superior labral (SLAP) tears and rupture with a bulging belly (Popeye sign)
Tight in: Shoulder extension with the elbow straight and the forearm pronated

Relations

Course: From the supraglenoid tubercle and superior labrum it arches over the top of the humeral head inside the joint, crosses the rotator interval and leaves down the intertubercular groove to its belly in mid-arm
Above: Supraspinatus tendon and the coracohumeral ligament, in the rotator interval
Medial: Subscapularis tendon at the lesser tubercle and the medial wall of the groove
Lateral: Greater tubercle and the lateral lip of the groove, where the pectoralis major inserts just below
In front: Transverse humeral ligament, then the anterior deltoid; the ascending branch of the anterior circumflex humeral artery runs up the groove beside it

How to find it

With the arm at the side, the elbow bent to 90° and the forearm turned slightly outward, the intertubercular groove faces forward a few centimetres below the acromion; the tendon is felt in the groove and rolls under the finger as the arm is turned in and out.

Examination

Speed's test: arm forward-flexed to about 90°, elbow straight, palm up, pressed down; pain in the groove suggests biceps tendinopathy or a SLAP lesion
Yergason's test: elbow bent 90° at the side, resisted supination; pain in the groove, or a click as the tendon slips out, suggests tendinopathy or instability
O'Brien (active compression) test: arm flexed 90°, slightly adducted, thumb down, pressed down; deep pain that eases with the palm up suggests a SLAP lesion
Popeye sign: on elbow flexion the belly bunches up in the lower arm; indicates a rupture

On imaging

Ultrasound follows it in the groove in short axis and shows fluid around it, medial dislocation (best on dynamic lateral rotation) or an empty groove after rupture. MRI and MR arthrography show its intra-articular part and the superior labrum (SLAP lesions).

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

Tenotomy or tenodesis is a common treatment of a painful tendon, often during cuff repair; tenotomy may leave a Popeye deformity and arm cramping
It is the first landmark seen from the posterior arthroscopic portal, crossing the rotator interval
Its origin shares the superior labrum, so traction in throwers can cause SLAP tears (superior labrum, anterior to posterior)
Tenodesis below the pectoralis major tendon removes the painful groove segment; the musculocutaneous nerve lies just medial

Anatomical variants

The origin of the biceps varies in roughly a third of people; a third head, usually from the humerus, is found in a few percent (more in some series)

Test yourself

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

Where does the long biceps tendon arise, and how does it relate to the joint?

From the supraglenoid tubercle and superior labrum; it crosses the joint inside the capsule but outside the synovium.

What holds the long biceps tendon in its groove?

The biceps pulley (coracohumeral and superior glenohumeral ligaments with upper subscapularis fibres) and the transverse humeral ligament.

What is Yergason's test for the long biceps tendon?

Elbow bent 90° at the side, resisted supination; pain in the groove, or a click as the tendon slips out, suggests tendinopathy or instability.

What does rupture of the long biceps tendon look like, and how much strength is lost?

The belly bunches lower in the arm on elbow flexion; flexion and supination are largely kept by the short head and brachialis.

Why can traction on the long biceps tendon in throwers cause SLAP tears?

The tendon's origin shares the superior labrum.

Add to my cards (5)

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

Its names

Official Latin (TA2): tendo capitis longi musculi bicipitis brachii TA2 2465
Official Spanish (DeCS): Tendón de la cabeza larga del bíceps braquial
English (TA2): Tendon of the long head of biceps
Also called: LHB tendon

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

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.