Nature abhors a vacuum: bilateral prominent rotator cable in bilateral congenital absence of the long head of the biceps tendon.

Bilateral agenesis of the long head of the biceps tendon is an exceedingly rare anomaly and can be a challenging diagnostic dilemma whose differential diagnosis includes tear. We present the third case of bilateral agenesis of the long head of the biceps tendon. Absent or shallow intertubercular sulcus is a constant finding and serves to differentiate this entity from tear. Our case is unique in that there was a radial ray anomaly, where prior reports of bilaterality did not demonstrate associated congenital anomalies. We also describe the newly reported finding of thickening of the rotator cable without the presence of rotator cuff tear. Thickening of the rotator cable may be an associated finding with agenesis of the biceps tendon.