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Biceps Tendon Tear

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What is a biceps tendon tear?
The biceps muscle has two proximal tendons (long and short head) and one distal tendon crossing the elbow.
Tears may occur proximally (at the shoulder) or distally (at the elbow).
What are the causes of a biceps tendon tear?
“This condition is frequently caused by sudden trauma from heavy lifting, falls, or sports-related injuries,” says Dr Markham.
“If your GP suspects a distal tear, we do leave spaces in our urgent clinic weekly for patients who require urgent types of surgery like this.”
What are the different types of biceps tendon tears?

Proximal Tear
“A proximal tear often involves the long head tendon at the shoulder and may be partial or complete,” says Dr Markham.
“These are common in older adults (over 60) and are often minimally symptomatic.”
He says the majority of proximal tears tend to be partial and most commonly do not require surgery.
“These tears respond well to non-surgical interventions such as rest and ice, immobilisation with a sling or brace, anti-inflammatory medications, and physical therapy to gently restore range of motion without adding stress to the tendon.”
He says in elderly patients with a proximal biceps rupture, a conservative approach is usually adopted as most will be asymptomatic after four to six weeks.
“In younger people, an isolated tear is also often managed conservatively. Occasionally a proximal tear will occur in conjunction with a rotator cuff lesion.”
Dr Markham says a complete rupture will result in a ‘Popeye Deformity’ where the bicep bunches up and bulges out.
“Some patients live with this, while others opt for surgical repair because the affected bicep can appear deformed.”
Once mobility improves, light strengthening exercises are introduced and patients can slowly return to normal activities after three months.
It is important to avoid any overhead lifting or overhead movements in the early weeks of recovery.

Distal Tear
A distal tear occurs near the elbow and is generally more severe and functionally limiting. This tear typically affects middle-aged men during heavy lifting or sports and requires urgent intervention.
“Distal tears are rare. Approximately 96% of biceps tendon tears are proximal and only 4% are distal. But when distal tears occur, they need prompt treatment,” says Dr Markham.

What are the symptoms of a biceps tendon tear?

Proximal Tear

  • Audible “pop” at the time of injury
  • Pain and tenderness at the shoulder
  • Weakness and instability in shoulder movements
  • Popeye Deformity — bulging of the biceps muscle above the elbow
  • Bruising and swelling
  • Sharp and sudden upper arm pain

Distal Tear

  • Audible “pop” at the time of injury
  • Pain and tenderness at the elbow
  • Weakness in bending the elbow or rotating the forearm (palm upwards)
  • Sharp pain at the front of the elbow
  • Bruising and swelling
Do I need surgery for a biceps tendon tear?

While you may be able to live with a Popeye deformity from a proximal biceps tendon tear, surgical repair may not be possible if left for more than four weeks..
“Distal ruptures that are more than four weeks old are considered chronic and may be more difficult to fix, may require a graft, and have less predictable outcomes.
“This is a case where referral to an orthopaedic surgeon is quite urgent.”
Recovery following surgery for a distal biceps tear (or, less commonly, a proximal tear) typically spans three months and includes:

  • Pain management
  • Immobilisation with a splint or brace
  • Early range of motion exercises
  • Keeping the elbow elevated to reduce swelling

The vast majority of proximal biceps tendon ruptures do well with conservative management.
Patients who are young and active, unwilling to accept cosmetic deformity, or unable to tolerate mild fatigue or cramping may be referred for a surgical opinion.

Will I regain full strength after a biceps tendon tear?
While many people regain full strength or near-full strength after a proximal tear, some may experience lingering weakness or decreased performance.
This is much more noticeable in an untreated distal biceps tendon tear, significant supination strength (rotating the arms so the palms face upwards) can result in significant weakness and elbow bending strength.
“If you think about the times you need to rotate your palm during the day, whether it’s to hold something, catch something, turn a doorknob, use a screwdriver, or start a car, these injuries can be quite restrictive for people who need full arm strength,” says Dr Markham.
Can I still exercise with a biceps tendon tear?
“Depending on the severity of the tear, some low-impact exercises are permitted, and low-impact range-of-movement exercises after surgery are especially important,” says Dr Markham.
“Return to sports can take weeks or months depending on when you receive clearance from your surgeon.”
Are there any long-term effects of a biceps tendon tear?
“While most patients with a proximal tear return to previous or similar levels of activity and function, some may experience chronic pain or weakness in the affected arm.
With a distal injury, the permanent damage is severe and rapid.

Disclaimer
This information is for educational purposes only. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Source:
BCMJ Journal, 2017 — Proximal vs Distal Biceps Ruptures: When to Refer
GP Notebook — Biceps Rupture

This page was reviewed by Dr Philip Markham June, 2026
AHPRA Registration No. MED0001196569
BMedSci, MBChB, MRCSEd, FRACS, FAOrthA

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