• Tendinopathy of the long head of the biceps brachii tendon (LHBT) can be associated with a number of shoulder conditions, including rotator cuff pathology, superior labral tears, subacromial impingement, or glenohumeral arthritis.

• Biceps tenodesis involves detachment of the LHBT from the superior labrum and reattachment to the proximal humerus.

• Biceps tenodesis is indicated for partial-thickness tear, tendon subluxation, superior labrum anterior to posterior (SLAP) tears, and failed nonoperative management of bicipital tenosynovitis.

• Advantages of tenodesis are protection of the length-tension relationship of the biceps, thereby maintaining elbow flexion and supination strength; avoidance of muscle atrophy and cramping; and prevention of the cosmetic deformity associated with biceps tenotomy.

• The LHBT originates at the superior aspect of the glenoid fossa and labrum at the supraglenoid tubercle.

• Although there is some anatomic variation, it usually attaches in the posterior aspect of the superior labrum and attaches directly to the supraglenoid tubercle.

• The tendon is encased within a synovial sheath in the glenohumeral joint and courses through the bicipital groove in the proximal humerus to join the lateral head of the biceps muscle. Therefore, the LHBT is an intra-articular (but extrasynovial) structure, passing an average of 35 mm over the head of the humerus and into the bicipital groove, becoming extra-articular.

• The tendon makes a 30- to 40-degree turn into the bicipital groove, where it is stabilized by the biceps pulley (composed of fibers from the coracohumeral and superior glenohumeral ligaments) and contributions from the subscapularis and supraspinatus tendons.

• The average length of the LHBT from the supraglenoid tubercle to the musculotendinous junction is 11.2-13.8 cm, and the average diameter is 6 mm.

• The tendon’s blood supply arises from the brachial and deep brachial arteries distally and the branches of the anterior humeral circumflex artery proximally; much of the intra-articular portion of the LHBT is poorly vascularized.

• The LHBT is at risk of injury, irritation, and degenerative changes because of its constrained course within the bicipital groove and its proximity to the acromion and rotator cuff, which subjects it to intra- and extra-articular restraints, possible subacromial impingement, and constant sliding of the tendon during shoulder motion.

• The biomechanical importance of the LHBT as a stabilizer of the glenohumeral joint continues to be controversial. Its primary function is at the elbow, where it acts as a flexor and supinator.

• Disorders of the LHBT can be classified as degenerative, inflammatory, traumatic, and instability.

• The most common complaint is anterior shoulder pain over the bicipital groove radiating to the biceps muscle.

• Pain at night and with rotation of the abducted arm also is common.