Biceps Tendon Rupture

To understand a Biceps Tendon Tear, we must first understand the anatomy of biceps. Biceps are muscles present in the front of the upper arm and stretches from shoulder to elbow. Tendons are tough connective tissues that help the bicep muscles attach to the bones at the shoulder joint and the elbow joint. Each biceps muscle has two heads (hence called biceps) which begin at the shoulder as two separate pieces and becomes a single piece midway down the upper arm. One of the tendons is called the long head, it attaches to the upper arm bone. The other tendon is the short head which attaches the biceps to a bony bump on the shoulder blade called the caracoid process.

When you have a torn bicep, one of these tendons is damaged or detaches from the bone. Any of these three bicep tendons can tear.

Biceps Tendon Rupture

A Biceps Tendon Tear or Injury is the rupture to these tendons. By this rupture, the muscle separates from the bones. The rupture can occur in the shoulder tendons or elbow tendons however it is more common in the shoulder tendons. When the rupture occurs in the tendons at the shoulder it is called proximal biceps tendon rupture and when it occurs in the tendons at the elbow it is called distal biceps tendon rupture.

The biceps muscle is used in performing a range of activities like lifting, rotating, bending the arm and reaching over the head. Hence a rupture to the biceps tendon affects these primary functions. A bicep tendon rupture can either be partial or complete. In partial, it does not completely tear the tendon whereas in complete the tendons are cut into two and separates from the bones.

Bicep tendonitis / tendinitis / tendinopathy / tendinosis / tenosynovitis/ Shoulder Biceps Rupture/ Ruptured Biceps at the Shoulder are all common terms that describes a tear or injury to shoulder’s bicep tendons.


Signs and Symptoms of a Biceps Tendon Injury


o          Pain at the front of the shoulder which worsens on performing activities like overhead lifting

o          Pain that radiates down the arm

o          An intermittent snapping or popping sound in the shoulder when you move it

o          Weakness in the shoulder and arm

o          Difficulty rotating your upper arm

o          Bulge above the elbow

o          Bruising to the upper arm


Causes of Bicep Tendonitis

Biceps tendon tears are common in bodybuilders and athletes who perform weight lifting and other repetitive activities. These injuries are more common in men than women. It is also a common sports injury for swimming, tennis, baseball, basketball etc. Other than this, it can occur in individuals due to trauma like accidents, due to old age.


Common risk factors that increases the chances of getting a Biceps Tendon Tear are:

o          Age – It is common in elderly people due to wear and tear of the tendons

o          Certain occupations – Like construction workers, porters who lift heavy

o          Smoking

o          Corticosteroid medications

o          History of shoulder problem


Diagnosing a Biceps Tendon Tear

The most common finding a biceps tendon rupture is bicipital groove point tenderness.  The pain can radiate towards the insertion of the deltoid muscle or down to the hand in a radial distribution.  It is seen that pain from the biceps rupture usually worsens at night, especially while sleeping on the affected shoulder.  Overhead motion of the arm, pushing or lifting may cause the pain to worsen.  Pain becomes very evident in the follow-through of a throwing motion.  An audible snap can be heard during the range of motion of the arm as a result of the instability of the tendon.


Your orthopedic doctor/shoulder specialist will diagnose a Biceps Tendon Tear with one or more of the following methods:

o          Studying your medical history – On your presentation to the clinic the doctor may ask if you have had a history of tendon ruptures.  This would help the doctor to delineate if you are at risk of having tendon ruptures.

o          Physical Examination – Patients with biceps tendon rupture often complain of a deep throbbing ache in the anterior shoulder.  The pain is usually localized to the biceps groove.  Through physical examination doctor can get a fair idea about the tendon rupture.  While examining the patient, s/he may stand with arm in 10 degrees of internal rotation.  During the external rotation of the arm the bicipital groove may in a posteroleateral position.  This is one of the tell-tale signs of a biceps tendon rupture.

o          X-rays – Although x-rays cannot show soft tissues like the biceps tendon, they can be helpful in ruling in/out other issues that can trigger elbow pain.

o          Ultrasonography – This imaging technique can reveal the free end of the biceps tendon that has recoiled up in the arm.

o          MRI Scans – Better images of the soft tissues can be obtained through this mode of imaging.  MRI images can show both partial and complete tears of the biceps tendon.


Treatment of Biceps Tendinopathy

Depending on the severity of the condition of your Biceps Tendon Injury as well as your overall bicep function and if you have damaged any other body part such as rotator cuff, your shoulder doctor will recommend the following course of treatment:

Rest – Refraining from dong exercising, lifting or holding anything heavy can help your recover from overuse injuries.  The objective behind rest is using your arm as little as possible.  Make sure you are not doing anything that causes pain, even if it does not seem to be strenuous.

o          Icing

Medications (Non-steroidal) – These are over-the-counter medications that can help relief from inflammation.  As you may be aware, inflammation is the hallmark of tendonitis.  Medications help reduce swelling from the tear of the biceps.  Pain arising out of biceps tendon injuries can also be reduced with medications

o          Medications (Steroids) – For cases where non-steroidal drugs does not improve the condition and the situation demands

Physical Therapy – With physical therapy rehabilitation you can regain strength and range of motion after a bicep tendon injury.  A physical therapist will guide you through a set of exercises designed to help you heal your injury and relieve pain.  Your therapist may also give your exercise sessions to be done at home once you are out of the main mode of treatment (as you make progress).  These might consist of stretches to flex and extend your arm, arm rotations, strength-building exercises like curls.

Torn bicep surgery – If none of the above-mentioned modalities of treatment help your injury heal or if tendon tear is large (as a rule of thumb, more than half), your doctor might recommend an operative procedure to repair the bicep tendon.  However, if the bicep tendon tear is at the elbow, surgery is recommended as a fist-line treatment.

Surgery for a long head of the biceps tendon tear is rarely needed. However, for some patients (particularly athletes) the conservative non-surgical treatment options does not help and those who  need complete recovery of the strength, surgery is recommended. Several new procedures like Biceps Tenodesis, Acriomioplasty and Direct Tenodesis have been developed which uses keyhole (arthroscopic) techniques to perform the correction.

In case a surgery is required, it is always better to perform it as soon as possible because otherwise the tendon gets retracted up the arm and gets stuck which becomes difficult to retrieve with small incisions.  Surgery is mainly done to reattach the tendon to the bone.


Rehabilitation post-surgery

Soon after the surgery, your doctor will ask you to wear a sling. You will be asked not to perform certain activities for a recommended period of time. Post which you will be put on a customized therapeutic exercise starting with slow exercises and leading to active strengthening exercises which will help gradually strengthen your muscles.


Torn bicep tendon recovery time:

Recovery time depends on the intensity of the tendon rupture as well as the nature of the treatment undertaken.  Seemingly mild ruptures can take up to two months to heal.  However, in order to get back to your activities of daily routine, you may have to wait out another four to five months.  Post surgery, you may be asked to wear a sling or otherwise immobilize your arm such as in a splint or cast for four to six weeks.  You may then be referred to have physiotherapy and exercises to gain the lost strength of the arm and facilitate range of motion.  Complete recovery from surgery can take about a year though most people recover much of the range of motion and strength in four to six months.

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Q&As on Biceps Tendon Rupture


  1. What are the types of biceps tendon tears?

Biceps tendon rupture is of two types – proximal or distal. Proximally, the biceps tendon is attached to the shoulder on the top and in the front by a long head and short head of the biceps muscle respectively. Distally, the biceps tendon is attached to the elbow. When the tear is proximal, the long head of the tendon is more likely to tear. The distal tear usually occurs during lifting heavy weights.

Biceps tendon rupture can be partial or complete. Mostly, tears don’t completely sever the tendon, while a complete tear splits the tendon into two pieces.


  1. What are the symptoms of biceps tendon rupture?

The symptoms of biceps tendon rupture include sudden, sharp pain in the upper part of the arm and shoulder depending upon the site of tendon rupture. You may hear a popping sound or tearing sensation at the time of injury. You may have difficulty turning the hand palm up or down. You may feel weakness in your arm muscles. A bulge may appear in the upper arm as a torn tendon will not be able to hold it tight. There will be warmth and swelling at the site of injury. You may also notice bruising near the lower end of the arm.


  1. How is biceps tendon rupture diagnosed?

The doctor will ask about your medical history and will discuss symptoms. After that, the doctor will examine your shoulder. A complete tear is diagnosed easily because of deformity of the arm muscle. To diagnose a partial tear, the doctor may ask you to bend your arm and tighten the muscle. The doctor may ask to go for imaging techniques like X-ray or MRI. The X-ray helps to rule out other deformities and injuries in the shoulder joint.

The distal tear will cause a gap in front of the elbow.


  1. How much time does a ruptured tendon take to recover?

Recovery time depends upon the severity of your injury as well as the treatment approach. Even minor tears take 2-4 months to heal. 4-6 weeks of flexibility and strengthening exercises are required before you resume normal activities. After surgery, you’ll probably need to wear a sling or immobilize your arm with the help of a splint or cast for four to six weeks. Complete recovery takes almost one year.


  1. What are the treatment options other than surgery?

There are non-surgical treatment approaches but it depends on the extent of the injury. The treatment options include rest, ice packs, NSAIDs, and physical therapy. Applying ice for about 15-20 minutes 3-4 times each day can help you to keep swelling down. Avoid exercises, lifting, and holding heavy objects, as giving rest to your muscle will help in recovering. You may be advised to use a sling for some time. NSAIDs like ibuprofen, aspirin help in relieving pain and inflammation. Flexibility and strengthening exercises help to regain full range of motion and restore shoulder strength.

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