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Conclusion: The detour sign based on axial MRI may be regarded an additional useful anatomical feature that improves the diagnostic performance of MRI in the identification of SLBT lesions. Advances in knowledge: Recognition of the detour sign may enhance the diagnostic performance of the conventional MRI protocol over the MR arthrography protocol for SLBT.

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Objective: To determine whether detection of the detour sign via MRI indicates subluxation of the long head of the biceps tendon (SLBT) in the shoulder joint and to investigate the association of SLBT with the degeneration of the long head of the biceps tendon (LBT) and rotator cuff tears.

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Methods: This retrospective study included 65 patients with shoulder pain who underwent shoulder MRI and arthroscopic surgery. When axial images revealed that the LBT was displaced over the inner rim of the bicipital groove with some remaining contact with the groove (Criterion 1), or demonstrated a "detour sign" of the biceps tendon (Criterion 2), the lesion was diagnosed as an SLBT. Shoulder arthroscopy was used as the reference standard.

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Results: Arthroscopy identified SLBT in 18 patients. When the MRI diagnosis was based on Criterion 1 alone, SLBT was diagnosed with a sensitivity of 44.4-55.6% and 75.4-80% accuracy. However, when the MRI diagnosis was based on Criteria 1 plus 2, SLBT was diagnosed with a sensitivity of 83.3-94.4% and 78.5-81.5% accuracy. There was a significant difference (p < 0.05) in the diagnostic sensitivity of Criteria 1 and 2.

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