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The long head of the biceps brachii is a well-known “pain generator” in the shoulder. Biceps tendinitis, instability, and rupture encompass the majority of symptomatic lesions. Clinical diagnosis, particularly of biceps tendinitis, can be difficult, given the nonspecific physical examination findings. Treatment options are initially nonoperative, with surgical management reserved for specific presentations or refractory cases. In recent years, biceps tenodesis and tenotomy have become the mainstays of operative treatment. Management of biceps lesions must also involve consideration of other shoulder pathology, as they are often not an isolated finding. Although there remains debate on the best treatment options for long head of the biceps injuries, a review of current literature provides important principles that can help guide clinical decision making.