summary Biceps subluxation is a recognized cause of anterior shoulder pain usually associated with a subscapularis tear. Diagnosis can be suspected clinically with anterior shoulder pain made worse with provocative tests and confirmed with MRI studies to evaluate for concurrent subscapularis tear. Treatment involves an initial trial of NSAIDs, activity modification and physical therapy. Arthorscopic versus open biceps tenodesis/tenotomy with or without subscapularis repair is indicated for recurrent symptoms. Etiology Pathophysiology most commonly associated with subscapularis tears login to view 1 more bullet disruption of the biceps sling Anatomy Biceps tendon anatomy originates off supraglenoid tubercle and superior labrum stabilized by the biceps sling which is comprised of fibers of the subscapularis supraspinatus coracohumeral superior glenohumeral ligaments Function acts as dynamic stabilizer involved in movement such as shoulder flexion, abduction Complete glenohumeral anatomy Presentation Symptoms anterior shoulder pain may have sensation of clicking Physical exam of shoulder strength due to the association with subscapularis tears, strength of the subscapularis muscle should be performed biceps provocation tests Yergason's test login to view 1 more bullet Speed's test login to view 1 more bullet palpable click login to view 2 more bullets Imaging Ultrasound can give dynamic test of bicep instability MRI can show increased T2 signal, and displacement out of the bicipital groove coincides with subscapularis tears decreased angle between the long head biceps to glenoid during arthroscopy has been associated with biceps tendon subluxation Treatment Nonoperative NSAIDS, PT strengthening, and steroid injections indications login to view 1 more bullet technique login to view 1 more bullet Operative arthroscopic vs open biceps tenotomy vs tenodesis indications login to view 1 more bullet technique login to view 2 more bullets