The long head of the biceps (LHB) tendon travels intra-articularly. Starting from its origin—at the supraglenoid tubercle—and making its way to the entrance of the bicipital groove, it exits the joint at the level of the biceps reflection pulley (hereafter, pulley), a soft tissue sling stabilizing the tendon course. The histoanatomy of the pulley system has been described by Gohlke and Werner. The pulley is built by fibers of the coracohumeral ligament, the superior glenohumeral ligament, and the supraspinatus and subscapularis tendons. Figure 1 shows the typical arthroscopic view from the posterior standard portal. Lesions of the biceps pulley and instability of the LHB tendon are often found in patients with anterior shoulder pain.

It is generally accepted that dislocation of the LHB tendon is associated with rotator cuff lesions—particularly, the subscapularis tendon. Tendinosis, partial tearing, and dislocation of the LHB tendon have all been investigated as sources of anterior shoulder pain due to a high degree of innervation of the proximal third of the tendon. Repetitive wear and trauma to the restraining structures of the LHB tendon may also result in medial or lateral subluxation or dislocation of the tendon, which in many cases is related to tears of the subscapularis or supraspinatus cuff tendons.

Full Article: Lesions of the Biceps Pulley