Biceps Tendon Pathology and Surgical Interventions
Summary
Biceps tendon pathology encompasses a spectrum of conditions affecting the long head of biceps tendon (LHBT), including tendinopathy, partial and complete tears, instability within the bicipital groove, and degeneration often associated with rotator cuff disease. Clinical presentation ranges from anterior shoulder pain and mechanical symptoms to cosmetic deformity and functional weakness. Diagnosis relies on clinical examination supported by imaging modalities such as ultrasound and MRI, which characterise tendon integrity, tendon-pulley interaction and groove morphology. Surgical management is indicated when conservative measures fail or when structural lesions threaten shoulder function. Two principal techniques—tenotomy and tenodesis—offer reliable pain relief and restoration of strength, yet differ in complication profiles, cosmetic outcomes and rehabilitation protocols. Advances in arthroscopic and open approaches, fixation devices (interference screws, suture anchors) and anatomic understanding of the biceps reflection pulley have refined patient selection and procedural success. Global research efforts continue to elucidate the balance between technical complexity, postoperative morbidity and long-term function.
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Biceps Tendon Pathology and Surgical Interventions publication trend
The graph below shows the total number of articles in biceps tendon pathology and surgical interventions across all publications each year (not limited to Nature Index journals).
Technical terms
Long head of biceps tendon (LHBT): the proximal tendon of the biceps brachii that traverses the shoulder joint and enters the bicipital groove.
Tenotomy: surgical release of the LHBT from its origin, allowing the tendon to retract distally.
Tenodesis: surgical detachment of the LHBT followed by reattachment to the humerus, commonly within the bicipital groove or subpectoral region.
Bicipital groove: the osseous channel on the anterior humerus through which the LHBT runs.
Popeye deformity: a bulging appearance of the biceps muscle caused by distal retraction of the LHBT following tenotomy.
Biceps reflection pulley: a soft-tissue stabilising complex at the entrance to the bicipital groove that maintains LHBT alignment.
References
- A shallow morphology of the intertubercular groove is associated with medial and bilateral but not lateral pulley lesions. Knee Surgery, Sports Traumatology, Arthroscopy (2023).
- Biceps tenotomy versus tenodesis: patient-reported outcomes and satisfaction. Journal of Orthopaedic Surgery and Research (2020).
- Tenotomy or Tenodesis for the Long Head of Biceps Lesions in Shoulders: A Systematic Review and Meta-Analysis. PLOS ONE (2015).
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