Biceps tendon ruptures or tears

Biceps tendons attach the biceps muscle, found in the upper arm, to the elbow at the lower end with one tendon, and at the upper end around the shoulder joint with two tendons to two places on the shoulder blade.

A biceps tendon rupture can occur at either the upper end or at the lower end of the biceps muscle. The most common is a proximal (“near”) rupture, which occurs when either of the two tendons at the upper end around the shoulder joint—called the “long head” and “short head”—tears partially or completely. Most tears occur in the long head, and we can successfully treat most of these injuries without surgery.

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When the biceps tendon can rupture

The long head attaches to the top of the shoulder socket and is more vulnerable to injury. The short head attaches to a “bump” on the shoulder blade.

A biceps tendon rupture can be caused by an injury, but most often is the result of degeneration and repetitive movements, including during exercise or sports.

Turn to UCHealth for expert help

If your primary care provider has referred you to us for further diagnosis of a suspected tear, or if you have done something to your arm so now your biceps looks strange—like Popeye’s arm—make an appointment with a UCHealth orthopedic specialist so we can help.

Most biceps tendon tears can be treated nonsurgically, but we can perform minimally invasive surgery called arthroscopy to repair it if necessary. We will help you get back to the activities you live for.

Biceps tendon tears can be partial or complete—a complete tear actually separates the tendon into two pieces. For most cases, tears begin as fraying or weakening from aging or from overuse through repetitive motion. As the damage progresses, the tendon can present as partially torn, or even become a complete tear after an injury, such as from lifting a heavy object. Additionally, an injury such as a fall can cause your biceps tendon to tear.

Common symptoms include:

  • Audible “pop” or “snap” sound
  • Bruising from the middle of the upper arm down toward the elbow
  • Bulge in the upper arm above the elbow—“Popeye muscle”—with a dent closer to the shoulder
  • Cramping of the biceps muscle with strenuous use of the arm
  • Difficulty and pain turning the arm palm up or palm down
  • Pain or tenderness at the shoulder and the elbow
  • Sudden, sharp pain in the upper arm
  • Weakness in the shoulder, elbow and/or forearm

The short head of the biceps rarely tears, and most people can still use their biceps normally even after a complete tear of the long head. A biceps tendon tear can also result in damage to other parts of your shoulder, such as the rotator cuff tendons, so a thorough diagnosis is critical to healing and a full recovery.

Many people can still function with a partial biceps tendon tear of the long head, and only need nonsurgical treatments to relieve their symptoms. Nonsurgical treatment can be very effective, especially if there’s no other damage to the shoulder. This includes:

  • Medication. Pain often resolves by itself over time. Nonsteroidal anti-inflammatory drugs like ibuprofen or naproxen can reduce pain and swelling. Check with your provider before taking.
  • Ice. Apply cold packs for 20 minutes at a time, several times a day to keep down swelling. Do not apply ice directly to the skin.
  • Rest. Avoid heavy lifting and overhead activities. We may recommend using a sling for a short period of time.
  • Physical therapy. Restores flexibility, movement and strength to your shoulder.

Mild arm weakness or arm deformity may occur, but is often not a significant problem for most patients. You can expect symptoms from a torn biceps tendon to improve over several weeks to several months. You may be able to resume some activities earlier.

In certain rare cases your UCHealth orthopedic specialist may recommend a surgical procedure, such as a biceps tenodesis, if these measures don’t relieve symptoms, if you develop persistent pain or cramping of the muscle, or if you require complete recovery of strength, as in the case of many athletes.

We also recommend surgery for complete tears if they occur at the elbow and we need to reattach the tendon to the bone. Initial recovery time after surgery is typically six to eight weeks. Our orthopedic specialists are experts in all the latest procedures with minimal incisions, and will discuss the best procedure for your case.

Whether your personalized treatment plan involves nonsurgical treatment or a leading-edge surgical procedure, your orthopedic team is dedicated to helping you heal from your biceps tendon rupture.

Your commitment to a custom program of physical therapy is critical to quick healing. We are here to help in any way so that you can once again enjoy the activities that make you healthy and happy.

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Orthoinfo: American Academy of Orthopaedic Surgeons. Biceps Tendon Tear at the Shoulder (https://orthoinfo.aaos.org/en/diseases–conditions/biceps-tendon-tear-at-the-shoulder/)

National Center for Biotechnology Information (NCBI): National Library of Medicine. Biceps Tendon Rupture (https://www.ncbi.nlm.nih.gov/books/NBK513235/)