The long head of the biceps tendon is frequently a significant source of pain in the shoulder as a result of pathology related to instability, trauma, or inflammation. When conservative measures at treatment have failed, surgical tenotomy or tenodesis are options for treatment. Many authors believe that tenodesis decreases the risk of cosmetic deformity, strength loss and cramping inherent to biceps tenotomy alone. Biceps tenodesis was originally described by Gilcreest, and has been performed by a variety of surgical methods in the ensuing years. Among these methods, differences center around open versus arthroscopic techniques, location of tenodesis and method of fixation. Although many authors report good short term outcomes with proximal techniques, long term results have been less encouraging. Tenodesis of the biceps tendon proximal to or within the biceps groove does not address residual synovium in this area which could act as a persistent pain generator. As a result, arthroscopically assisted open subpectoral tenodesis has evolved as a viable method which allows assessment and treatment of intra-articular pathology, as well as a cosmetically acceptable tenodesis at the distal portion of the intertubercular groove. This method also has the advantage of technical simplicity and utilization of an intermuscular interval for surgical dissection.