The proximal aspect of the long head of the biceps brachii (LHBB) has long been implicated as a pain generator in the shoulder. Biceps tenodesis is one surgical treatment option for refractory biceps tendonitis. The purpose of this study was to examine the tendinopathic changes in the intra-articular segment of long head of the biceps tendon as well as all three zones of the bicipital tunnel in a cohort of patients with chronic refractory biceps symptoms