INTRODUCTION:
Injuries to the biceps reflection pulley (BRP) are mostly reported in patients complaining of anterior shoulder pain and commonly correlated to other shoulder diseasessuch as rotator cuff injuries, SLAP lesions, biceps instability, and biceps tendon tears. Injuries of the biceps pulley system of the long head biceps tendon (LHBT) are distinct and frequent cause of anterior shoulder pain. Many authors have discussed correlations with rotator cuff injuries, acute trauma, frequent micro trauma, SLAP lesions, and soft tissue degeneration. Additionally, number of studies have documented and hypothesized that a dynamic process of degeneration started with a trauma to the pulley system of the LHB and progressedto partial tears in the surrounding rotator cuff and ultimately to a complete tear.
When there is a rotator cuff injury, the biceps pulley may be strained by the unstable biceps tendon, which may then compromise the subscapularis tendon's stability. It is necessary to differentiate between normal variants and lesions of the biceps pulley that impact anterosuperior injuries in case of rotator cuff tear.