Biceps tendon tear

The biceps muscle at the front of the upper arm is attached to bone by tendons at both ends. At the shoulder, the biceps has two tendons, and the long head tendon is the one that usually tears. At the elbow, a single tendon, the distal biceps tendon, attaches the muscle to the forearm. Tears can be partial or complete, and the two locations are treated quite differently.

• Sudden, sharp pain in the upper arm or at the front of the elbow, sometimes with a pop
• Bruising in the upper arm, or at the elbow and forearm
• A bulge in the upper arm (sometimes called a "Popeye" muscle) as the muscle bunches up
• A gap or dent at the front of the elbow with an elbow tear
• Weakness bending the elbow and, especially with an elbow tear, turning the palm up
• Biceps cramps during or after hard use of the arm

At the shoulder, tears often follow gradual wear of the tendon and frequently occur alongside rotator cuff problems. Heavy lifting, repetitive overhead work or sports, and increasing age add to the risk.

At the elbow, tears usually happen suddenly, when a bent elbow is forced straight against a heavy load, such as catching or lifting a box that is heavier than expected. They occur far more often in men than in women.

Smoking and corticosteroid medications weaken tendons and raise the risk at both locations.

A clinician looks at the shape of the muscle, feels for the tendon, and tests strength in bending the elbow and rotating the forearm. An ultrasound or MRI can confirm the diagnosis and show whether a tear is partial or complete. With a tear at the shoulder, the rotator cuff and other shoulder structures are also checked.

Shoulder (proximal) tears: most are treated without surgery. Because the short head of the biceps still anchors the muscle, most people keep good use of the arm. Ice, rest, anti-inflammatory medication when appropriate, and physical therapy help pain settle and restore strength and motion; the bulge in the upper arm usually remains. Surgery to reattach the tendon to the upper arm bone (biceps tenodesis) may be considered for people who need full strength for work or sport, for ongoing cramping or pain, or when another shoulder problem, such as a rotator cuff tear, needs surgery at the same time.

Elbow (distal) tears: a complete tear does not heal back to the bone on its own and typically leaves lasting weakness, especially in turning the palm up and in bending the elbow. Surgery to reattach the tendon is commonly recommended for active people and is usually done within the first few weeks after the injury, before the tendon pulls back and scars. Non-surgical care may be reasonable for some partial tears and for some people with lower physical demands on the arm.

After an elbow repair, a splint or brace protects the repair at first, motion is restored gradually, and lifting restrictions last for several months. After a biceps tenodesis at the shoulder, a sling is used for a short time before rehabilitation. With non-surgical care, physical therapy helps the arm regain strength and comfort over weeks to months.

Lifting with good technique, not trying to catch or lift loads you cannot safely control, keeping the shoulder muscles strong, getting shoulder pain checked early, and not smoking can lower the risk of a tendon tear.