Introduction: The long head of the biceps (LHB) tendon is recognized as a pain generator in the shoulder. Although isolated LHB tendon pathology can occur, it is more frequently encountered with other conditions of the shoulder, particularly impingement, rotator cuff tears, and labral tears. Failure to treat LHB tendon disorders during arthroscopy for other associated shoulder pathology can lead to continued postoperative pain and dissatisfaction. Current surgical treatment options for LHB disorders include tenotomy and tenodesis. Tenodesis is preferred for younger, high-demand patients to prevent biceps cramping and deformity. Subpectoral tenodesis provides reliable treatment for all LHB pathology, including isolated biceps tendonitis or tears, superior labrum anterior to posterior (SLAP) tears extending to the biceps, biceps subluxation or instability, and type II SLAP tears. This video demonstrates the authors' preferred technique for subpectoral biceps tenodesis using bone tunnels with suture fixation.Methods: This video describes the indications, technique, and results for open subpectoral tenodesis. It includes both arthroscopic findings and open intraoperative recording of the authors' subpectoral biceps tenodesis technique. A step-by-step commentary about this technique, including exposure and anatomical dissection, bone tunnel formation and suture fixation, and closure are provided. The clinical results of 102 patients treated with this technique will also be revealed.Results: Patients with an average age of 53.8 years were treated with open subpectoral biceps tenodesis by the senior author between 2005 and 2012 with a minimum 1-year follow-up. One hundred patients (98%) had a satisfactory result with no biceps pain and no recurrent deformity. One patient reported persistent biceps pain, one patient experienced a loss of fixation with recurrent deformity, and another developed a postoperative infection that resolved with irrigation and débridement of the surgical site.Conclusion: Open subpectoral biceps tenodesis with bone tunnel and suture fixation is a reliable treatment option for all biceps tendon pathology. This technique demonstrates a high success rate, provides consistent pain relief and dependable fixation, and is associated with minimal additional implant costs.