Background <p>Pathologies of the long head of the biceps (LHB) tendon are common, including tendinopathy, instability, pulley lesions and SLAP lesions. Lesions of the short head of the biceps (SHB) tendon are rare, mostly traumatic or iatrogenic but can be clinically relevant in complex injury patterns, such as superior shoulder suspensory complex (SSSC, floating shoulder) injuries.</p> Objective <p>Presentation of current diagnostic and treatment concepts for proximal biceps tendon pathologies and the coracoid region, with a&#xa0;focus on differentiated indications.</p> Material and methods <p>Selective review of the current literature, complemented by clinical experience and illustrative cases from arthroscopic and open surgery.</p> Results <p>Conservative treatment is the first choice for LHB pathologies. In cases of persistent symptoms or structural lesions, tenotomy and tenodesis are established surgical options. Both yield comparable functional outcomes but differ in cosmetic results (higher rate of Popeye deformity after tenotomy) and muscular cramping rates. Anatomical repair (SLAP, pulley) is successful in young, active patients, while tenodesis is preferable for degenerative alterations. Pathologies of the SHB can be treated conservatively in cases of low functional demands, whereas traumatic ruptures and complex injury patterns require surgical reconstruction.</p> Conclusion <p>Individualized decision-making considering age, functional demands, cosmetic expectations and concomitant pathologies is essential for an optimal outcome.</p>