Biceps Tendinopathy (Long Head)

What is it?

Long head biceps tendon inflames in the bicipital groove, typically with concurrent rotator cuff pathology or impingement.

Commonly affected: Long head biceps tendon within the bicipital groove

How it develops

1. Normal Long Head BicepsOriginates intra-articularly, runs through bicipital groove
2. Impingement/RC PathologyAssociated impingement or rotator cuff disease irritates biceps
3. Tendinitis/TenosynovitisTendinitis and tenosynovitis in the groove
4. Tendon Rupture RiskChronic cases may rupture (Popeye sign)

Symptoms

• Anterior Shoulder PainLocalized over bicipital groove
• Lifting PainWorse with elbow/shoulder flexion
• Radiation to ForearmPain radiates along anterior arm to elbow
• Popeye Sign (if ruptured)Muscle bulge in mid-arm if LHB ruptures

How it is examined

• Speed's TestResisted shoulder flexion with extended elbow reproduces pain
• Yergason TestResisted supination with elbow at 90° reproduces groove pain
• Groove TendernessDirect tenderness over bicipital groove
• Concurrent RC EvalPerform concurrent impingement tests

Imaging

X-ray often normal; useful to assess impingement.

• Acromion morphology
• Rarely groove abnormality
• Possible RC calcifications

MRI/US confirm tendinitis, fluid, or rupture.

• Fluid in groove
• Tendon thickening
• Empty groove if ruptured
• Concurrent rotator cuff pathology

When surgery is considered

6-month failure, partial tear, or during concurrent RC repair

Procedures that may be discussed

• Arthroscopic biceps tenotomy
• Biceps tenodesis

Outlook

70–80% improve conservatively; excellent surgical outcomes.