Disorders of the long head of the biceps tendon.

The functional importance of the long head of the biceps tendon is a source of debate. Despite the controversy concerning its functional role, the long head of the biceps tendon is a recognized pain generator in the shoulder. Because long head of the biceps tendinopathy is commonly associated with other shoulder pathologies, a thorough assessment and examination are critical to making the correct diagnosis and choosing a management plan. If nonsurgical treatment has failed, biceps tenotomy and biceps tenodesis can provide pain relief. Biceps tenodesis is reserved for young, higher demand patients; requires more rehabilitation time; and has a higher cost. All-arthroscopic proximal tenodesis and distal open subpectoral tenodesis have advantages and disadvantages. Although recent midterm reports suggest slightly better revision and complication rates with subpectoral tenodesis, more studies are needed to verify these findings. Persistent shoulder symptoms after biceps tenodesis commonly occur secondary to missed or untreated associated shoulder pathologies but also may result from mechanical failure of the tenodesis.