ABC Medical Center > Diseases > Bicipital Pulley Lesion

What is bicipital pulley lesion?

26 January 2026

The bicipital pulley is composed of the coracohumeral ligament and the superior glenohumeral ligament. Therefore, when an injury occurs in this area, we are talking about damage to the ligaments that surround the biceps tendon. This injury does not initially affect the rotator cuff, although it may later compromise its function.

The biceps pulley can tear due to various causes such as:

  • Trauma.
  • Repetitive movements.
  • Various injuries.

As these elements are important for stabilizing the shoulder joint, the longitudinal portion of the biceps tendon and the rotator interval can present congenital or acquired lesions. If the former reports instability, the latter can also show dysfunction and painful episodes.

Classification of Bicipital Pulley Lesion Types

  • Type I: Damage occurs only in the ligaments without affecting the rotator cuff.
  • Type II: Affects the supraspinatus tendon due to damage to the pulley and biceps subluxation.
  • Type III: Deeply damages the subscapularis tendon, in addition to injuring ligaments and manifesting biceps subluxation.
  • Type IV: The biceps tendon is dislocated and presents tearing of the subscapularis and supraspinatus tendons.

Signs and symptoms Bicipital Pulley Lesion

The symptoms are:

  • Pain.
  • Inflammation (swelling).
  • Stiffness.
  • Limitation of movement.

Diagnosis and treatment Bicipital Pulley Lesion

Once the orthopedist analyzes your symptoms and clinical history, they will perform a physical examination with special attention to the biceps area. However, issuing a diagnosis can be complicated, even with the help of conventional imaging studies. Currently, arthro-MRI (Magnetic Resonance Arthrography) is used, a test that has proven to be more effective for anatomically evaluating possible instabilities of the bicipital pulley and dysfunctions of the rotator interval, thanks to its power to visualize the bicipital pulley ligaments and the small, deep tissue damage to the subscapularis and supraspinatus tendons.

The treatment to follow will depend on the type and severity of the injury, but it usually includes:

  • Analgesics (painkillers).
  • Anti-inflammatories.
  • Surgery.
  • Physical therapy.

At the Orthopedics and Traumatology Center, we seek to improve the lives of patients restricted or immobilized by musculoskeletal disorders or injuries. We specialize in the care of the musculoskeletal system by integrating the latest medical, biological, and technological advances, in strict adherence to the highest international standards of patient care.

Related centers and departments Bicipital Pulley Lesion

Orthopedics and Traumatology Center
High Specialty Surgery Center
Radiology and Molecular Imaging
Clinical Laboratory

Sources:

  • aaos.org
  • orthoinfo.aaos.org
  • cun.es
  • fisify.com
  • mayoclinic.org
  • medlineplus.gov
  • topdoctors.es
  • medigraphic.com
  • Valero GFS, Hiramuro SF, Encalada DMI. Lesiones del tendón del bíceps, manejo actual. Ortho-tips. 2014;10(3):154-162.
  • Álvarez LA, García LYC. Lesiones del bíceps en la inserción del reborde glenoideo superior. AMC. 2017;21(3):400-408.
  • Forns G, Simone J, Varaona J. Reparación aguda del bíceps distal mediante técnica de doble incisión: resultados de un protocolo estandarizado de rehabilitación domiciliaria. Acta Ortop Mex. 2021 Sep-Oct;35(5):405-410. doi:10.35366/104566.
  • Fernández LLA, Sánchez OJA, Martín LR, et al. Rotura del bíceps braquial distal. Reporte de cuatro casos. Mediciego. 2016;22(Suppl: 1):36-45.

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