The Empty Bicipital Groove - A Pictorial Essay on the Congenital Absence of Long Head of Biceps Tendon and other Biceps Tendon Pathologies

An empty bicipital groove may be congenital or post-surgical. Congenital absence of long head of biceps tendon is rare and often missed on MRI unless the radiologist has a high index of suspicion. Surgical treatment such as biceps tenotomy or tenodesis will also demonstrate an empty bicipital groove. Long head of biceps tendon pathology is a common cause of anterior shoulder pain as it faces both intra-articular and extra-articular constraints resulting in tendinopathy, tenosynovitis, tear or subluxation. However, the proximity to other structures such as the coracohumeral ligament, superior glenohumeral ligament, rotator cuff muscles and glenoid labrum gives rise to a diagnostic challenge in patients with anterior shoulder pain. We present a rare case series of congenital and post-surgical empty bicipital groove and other long head of biceps tendon pathologies in the context of an empty bicipital groove. Radiologists should be mindful of such an entity as they may be the first to encounter the imaging features and clinical scenario.