Incidental detection of congenital absence of the long head of the biceps tendon during shoulder arthroscopy: A case report.

Although congenital variations of the biceps brachii are relatively common, agenesis of the long head is exceedingly rare. Due to the absence of clinical symptoms and notable physical examination findings, its diagnosis is challenging. The absence of the long head repre-sents one such variant, although it has only rarely been reported in arthroscopic and imaging studies. As this anomaly does not result in functional impairment, congenital biceps agenesis is often incidentally detected on shoulder magnetic resonance imaging performed for other reasons. In this case report, we present a 42-year-old industrial worker with a two-year history of persistent pain who under-went rotator cuff repair, during which an absent long head of the biceps tendon was incidentally identified. Current evidence suggests that the absence of the long head of the biceps tendon is not a risk factor for rotator cuff rupture or labral pathology. Additionally, when evaluating patients with an absent long head of the biceps tendon, it is essential to consider any previous surgical interventions. If the long head cannot be identified, the distal portion of the tendon should be carefully assessed, as the most common cause of its ab-sence near the shoulder is not a congenital condition but rather a complete tear causing the tendon to retract downward. This condi-tion represents an incidental anatomical variation and does not contribute to the functional impairment observed in these conditions.