Biceps Tears

A biceps tendon tear happens when one of the tendons that anchor the biceps muscle pulls free. At the shoulder, the long head of the biceps tends to tear after years of gradual wear, and the muscle then bunches into a ball lower on the arm, the Popeye deformity. At the elbow, the single distal tendon can pull off the forearm bone. A torn tendon does not reattach on its own, but the strength that is lost depends on which tendon tore and which one remains intact.

The symptoms of a tear at the shoulder are usually sudden and recognizable. Common symptoms include:

• A pop at the front of the shoulder, sometimes with a lift and sometimes with a lighter movement
• Sharp pain that often settles within a few days
• Bruising that tracks from the shoulder down the inside of the upper arm
• A bulge in the upper arm, most obvious when the elbow is bent
• With a tear at the elbow, weakness turning a doorknob, using a screwdriver, or lifting with the palm up

The visible bulge is often enough to identify a tear at the shoulder, and bruising along the upper arm confirms an acute event. A focused exam of the shoulder and elbow checks for associated rotator cuff tenderness. An MRI is not always needed but is often added to evaluate the rotator cuff, which is frequently involved, or to confirm a suspected tear at the elbow.

Nonsurgical care is the right choice for most people with a tear at the shoulder, because the short head of the biceps stays intact and handles most of the work for elbow bending:

• Rest and activity changes to let the pain and bruising settle
• Anti-inflammatory medication for pain and swelling during the acute phase
• Physical therapy, once the acute phase resolves, to restore motion and strength

Surgery is considered mainly for younger or highly active people who need full forearm-twisting strength, for those with heavy manual demands, and for patients who find the deformity unacceptable. A tear at the elbow is more often reattached surgically in active patients, because the strength loss without it is greater.

• Distal biceps repairElbow

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Biceps Tendon Tear at the Shoulder — AAOS OrthoInfo