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The clinical significance of the biceps tendon to shoulder function has been a subject of controversy for some time. The role of the biceps for shoulder motion, shoulder stability, and the development of shoulder pain has been debated for more than 50 years. Opinions on the relative contribution of the biceps tendon to the development of shoulder pain or dysfunction have varied significantly, with some suggesting only a vestigial function, and others believing it plays a critical role in shoulder stability. Because surgical treatment for disorders of the long head of the biceps tendon is limited to removal of the intra-articular portion of the tendon, with either tenotomy or tenodesis, treatment recommendations must consider the functional consequences of tendon loss. These functional considerations must, in turn, be balanced with concerns about the symptomatic consequences of a persistently diseased tendon. In this article, we review relevant concerns about the function and symptomatic significance of the long head of the biceps tendon. Treatment recommendations are made based on a review of the available information.