To identify the biceps tendon:

1. Patient with their hand resting on their lap. Palm upwards (external rotation) is best.
2. Palpate the anterior humeral head (bicipital groove if you can) and place the probe transversely.
3. Slide the probe superiorly and inferiorly to assess the entire tendon from the musculo-tendinous junction.

TIP: When you slide down, look for the pectoralis major tendon crossing over the biceps. This is the  level of the bicipital musculotendinous junction. You must extend beyond this point to check for retraction  if a tear is suspected.

Once you identify the biceps tendon:

1. Is it in the bicipital groove? (enlocated)
2. Is it intact?
3. Assess it from the superior humeral head (at the rotator cuff interval) to the musculo-tendinous junction inferiorly.
4. Is there fluid or synovial thickening of the sheath.

Normal appearance:

1. TRANSVERSE: Echogenic and ovoid (proximally, it is usually against the medial edge of the bicipital groove)
2. LONGITUDINAL: Echogenic and fibrillar.
3. SHEATH: a trace of simple fluid is physiologically normal.