Biceps tendon tear at the shoulder
A torn bicep tendon at the shoulder can cause weakness and make it difficult to rotate your arm.
Reviewed for medical accuracy by Professor Ali Noorani, Consultant Orthopaedic Surgeon.
What is a shoulder biceps tendon tear?
A biceps tendon tear at the shoulder is known as a proximal biceps tendon rupture.
The biceps muscle in the upper arm is attached to the shoulder by two tendons (a strong band of tissue). These are known as the long head and short head of the biceps.
Most proximal biceps tendon ruptures involve the long head of the biceps. Injuries to the short head are very rare. The long head of the biceps tendon attaches to the top of the shoulder socket (glenoid). It passes through the shoulder joint and along the front of the upper arm.
The biceps helps to bend the elbow and rotate the forearm so that the palm faces upwards. The long head tendon helps support the shoulder, but it can also be a source of pain and is often affected by other shoulder conditions.
A biceps tendon tear can be partial or complete. A sudden tear often happens when lifting, pulling, or trying to catch a heavy object. It can also happen after a fall onto an outstretched arm. Partial tears and tendon damage can develop gradually over time due to repeated heavy lifting, overhead activities, or long-term overuse.
Even when the long head of the biceps tendon tears, many people still have good movement and strength in their arm. This is because another part of the biceps tendon, called the short head, remains attached. Other muscles can also help compensate for the injury.
Some people notice reduced strength or muscle endurance, especially when repeatedly bending the elbow or turning the forearm. Strength loss is usually mild to moderate when only the long head tendon has torn.
Ruptures of the long head of the biceps tendon are common in men over 60. As we age, the tendon can become weaker and more prone to tearing. These injuries can also be linked to other shoulder problems, such as damage to the rotator cuff.
Biceps tendon ruptures can also affect younger, active people, including weightlifters, bodybuilders, and those whose work, sport, or hobbies involve regular heavy lifting.
What are the symptoms of a biceps tendon tear?
There is often a pop in the upper arm or shoulder when the tendon ruptures. Pain may be severe at first but often improves over the following one or two weeks.
Other symptoms may include:
- sudden, sharp pain in the upper arm near the shoulder
- a popping sound at the time of injury
- pain, tenderness, or weakness around the shoulder
- aching or cramping in the upper arm
- fatigue during repetitive lifting or activity
- difficulty turning the forearm so that the palm faces upwards or downwards
- a bulge in the upper arm, known as a Popeye sign
- bruising in the upper arm
- a change in the contour of the biceps muscle
How is a biceps tendon tear diagnosed?
Your specialist can usually diagnose a biceps tendon tear by asking about your symptoms and examining your shoulder and arm. They will look for changes in the shape of the arm, areas of tenderness, your range of movement, muscle strength, and any other shoulder problems.
You may need an ultrasound scan or MRI scan if the diagnosis is unclear, if a partial tear is suspected, or if your specialist thinks you may have another shoulder condition, such as a rotator cuff tear. Not everyone needs an MRI scan.
Biceps tendon tear treatment
Non-surgical
Most isolated proximal long head biceps tendon ruptures can be treated without surgery, even if the tendon has torn completely.
You may not need surgery if your pain is improving, you can still use your arm well, and you do not have significant cramping, weakness, or concerns about how your arm looks.
Treatment may include:
- Rest and changing your activities: Avoid heavy lifting and activities that cause pain, especially those that involve reaching above your head, while your shoulder settles. Your specialist may recommend a sling for a short time.
- Pain relief and anti-inflammatory medicines: Medicines may help reduce pain and swelling if they are suitable for you.
- Physiotherapy: Once your pain has improved, exercises can help you regain movement and strengthen the muscles in your shoulder, elbow, and forearm.
Your specialist will discuss whether surgery or non-surgical treatment is the best option for you. This decision depends on factors such as your symptoms, age, activity level, job, sports participation, concerns about appearance, and whether you have any other shoulder problems.
Surgery
Surgery is not needed for every complete proximal biceps tendon rupture.
Your specialist may consider surgery if you are younger or very active and continue to have symptoms such as ongoing pain, cramping, weakness, tiredness in the arm, difficulty using your arm, or concerns about how the arm looks after the injury.
Surgery may also be recommended if the tendon tear happens alongside another shoulder problem that needs an operation, such as a rotator cuff tear.
The most common operation is called biceps tenodesis.
During a biceps tenodesis, the surgeon attaches the torn tendon to the upper arm bone (humerus) instead of reattaching it to its original position in the shoulder. This helps reduce symptoms and improve arm function.
The surgeon secures the tendon to the bone using small surgical devices designed to hold it in place while it heals.
There are different ways to perform this operation. Your surgeon will choose the approach that is most suitable for your injury and individual circumstances.
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