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# Long biceps tendon

The long biceps tendon runs from the top of the shoulder socket down a groove in the [humerus](https://durgical.com/en/anatomy/humerus/); it links the biceps to the shoulder.

Official name: Tendon of the long head of biceps

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## 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 points

- Held in its groove by the biceps pulley (coracohumeral and superior glenohumeral ligaments with upper [subscapularis](https://durgical.com/en/anatomy/subscapularis/) fibres) and the transverse humeral ligament
- A medially dislocated tendon goes with a tear of the pulley or the upper subscapularis tendon, and the reverse
- Speed's and Yergason's tests load it; groove tenderness that moves as the arm is rotated is typical of bicipital tendinopathy
- Rupture leaves the belly lower in the arm (Popeye sign); flexion and supination strength are largely kept by the short head and [brachialis](https://durgical.com/en/anatomy/brachialis/)

## 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](https://durgical.com/en/anatomy/glenoid-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](https://durgical.com/en/anatomy/supraspinatus-tendon/) and the [coracohumeral ligament](https://durgical.com/en/anatomy/coracohumeral-ligament/), in the rotator interval

**Medial**
[Subscapularis tendon](https://durgical.com/en/anatomy/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](https://durgical.com/en/anatomy/pectoralis-major-muscle/) inserts just below

**In front**
[Transverse humeral ligament](https://durgical.com/en/anatomy/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](https://durgical.com/en/anatomy/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](https://durgical.com/en/anatomy/pectoralis-major-tendon/) removes the painful groove segment; the [musculocutaneous nerve](https://durgical.com/en/anatomy/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.

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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

## Related

- [Supraspinatus tendon](https://durgical.com/en/anatomy/supraspinatus-tendon/)
- [Subscapularis tendon](https://durgical.com/en/anatomy/subscapularis-tendon/)
- [Transverse humeral ligament](https://durgical.com/en/anatomy/transverse-humeral-ligament/)
- [Biceps tendon sheath](https://durgical.com/en/anatomy/intertubercular-tendon-sheath/)
- [Labrum](https://durgical.com/en/anatomy/glenoid-labrum/)
- [Biceps (long head)](https://durgical.com/en/anatomy/biceps-brachii-long-head/)
- [Humerus](https://durgical.com/en/anatomy/humerus/)
- [Scapula](https://durgical.com/en/anatomy/scapula/)

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/tendon-of-the-long-head-of-biceps/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/tendon-of-the-long-head-of-biceps/