Disorders of the long head of the biceps brachii tendon (LHBT) are a commonly recognized source of shoulder pain.1–5 it is not unusual to have LHB pathology associated with rotator cuff tears and subacromial impingement.6,7 Rotator cuff deficiency increases superior translation of the humeral head in relation to the glenoid fossa, causing the LHBT, a humeral head depressor, to be subject to overuse injury. Clinical success is always predicated upon an accurate diagnosis and understanding of the pathological process. While a careful history and a thorough physical examination are important steps in the assessment of LHBT pathology, it is still difficult to differentiate the type and severity of the pathology. Musculoskeletal ultrasound (MSK US) imaging has become an established tool to assist in and optimize the diagnostic process. While MSK US is very accurate in the diagnosis of rotator cuff tears, there is moderate to strong evidence to support the use of MSK US in diagnosis of LHBT pathology.8 MSK US can accurately help to diagnose partial and full-thickness tears, LHBT subluxation/dislocation, and LHB tendinopathy.8
At times, MSK US can be a difficult diagnostic tool to use clinically and interpret the results. However, when used correctly, MSK US is a valuable tool to accurately diagnose a variety of LHBT pathologies. Therefore, its use should help to facilitate diagnosis and treatment of patients with shoulder pain due to suspected biceps tendon pathologies. The goal of this article is to provide a few tips and tricks to assist in using MSK US as a diagnostic tool for the assessment of the LHBT.