Biceps Tendon Rupture

Overview

A biceps tendon rupture means one of the strong cords that attach your biceps muscle to bone has torn. A tendon is a tough cord that connects muscle to bone. The biceps has two tendons at the shoulder (the proximal tendons, meaning closer to the body) and one at the elbow (the distal tendon, meaning further down the arm). The long-head tendon at the shoulder is the most common one to tear. A tear can be partial or complete.

Tears of the long-head biceps tendon at the shoulder are fairly common in older adults, especially men. Complete tears of the distal biceps tendon at the elbow are uncommon.

It can affect anyone, but it is more common in men over 40, people who do repeated overhead or heavy lifting, and people whose tendons have worn with age. Distal tears often happen in middle-aged men during a single heavy strain. Tears are rare in children.

Symptoms

Common symptoms

• A sudden sharp pain in the front of the shoulder or elbow
• A snap, pop, or tearing feeling at the time of injury
• Bruising and swelling that may spread down the arm
• Weakness when bending the elbow or turning the palm upward
• A bulge or change in the shape of the upper arm, sometimes called a Popeye sign
• Pain when lifting, pulling, or reaching overhead

Symptoms in children

• Biceps tendon tears are rare in children.
• A sudden arm injury in a child may be a growth-plate injury or a bone injury instead, so it needs a clinician’s check.
• A child with arm pain, swelling, or unwillingness to use the arm after a fall or pull should be seen.

Symptoms in older adults

• The long-head tendon at the shoulder often wears with age and may tear with a minor lift or no clear injury.
• Pain may be mild, but weakness and a change in arm shape can still be present.
• Older adults may also have other shoulder problems, such as wear of the muscles and tendons that move the shoulder, that need assessment.

Causes

Main causes

• Wear and tear of the tendon over time
• A sudden heavy lift, pull, or strain
• A fall onto an outstretched arm
• Sports that involve repeated overhead motion or heavy lifting
• A direct blow to the arm

Risk factors

• Older age, especially over 40
• Being male
• Repeated overhead or heavy lifting at work or in sport
• A sudden increase in activity or poor lifting technique
• Smoking
• Some long-term health conditions and medicines can weaken tendons; ask your clinician about your own risk

When to see a doctor

See a doctor urgently if:

• You heard or felt a pop and have severe pain or swelling
• You cannot use the arm normally or cannot bend the elbow
• You have numbness, tingling, or a pale or cold hand
• You have an open wound over the arm
• You have fever, spreading redness, or warmth around the arm

Book a routine appointment if:

• Ongoing pain in the front of the shoulder or elbow
• Weakness when lifting or turning the palm upward
• A change in the shape of the upper arm
• Bruising after a strain that does not settle
• Difficulty with work, sport, or daily tasks

Diagnosis

A clinician will ask how the injury happened and examine your shoulder, elbow, and arm. They will check your strength, movement, and the shape of the arm. Imaging may be used to confirm the tear and to rule out a broken bone.

Tests that may be done

• X-ray to check for broken bones
• Ultrasound scan to look at the tendon
• MRI scan for a more detailed picture, especially if surgery is being considered

What to expect at your appointment

You may be seen by a general clinician first and then referred to a musculoskeletal or orthopaedic specialist (a doctor who treats bones, joints, and muscles) if needed. A distal tear at the elbow or a tear with major weakness may need a quicker specialist review.

Treatment

Treatment depends on which tendon is torn, whether the tear is partial or complete, and how much weakness or pain you have. Many people do well with physiotherapy and activity changes. Some tears, especially at the elbow, may need surgery.

Self-care at home

• Rest the arm from heavy lifting and painful activities for a short time
• Use wrapped ice for short periods to help with pain and swelling
• Follow advice about a sling or support if your clinician recommends one
• Start gentle movement and strength work as guided by a physiotherapist
• Ask your pharmacist or clinician about pain relief that is safe for you

Medical treatments

Physiotherapy is the main treatment for many biceps tendon tears. It focuses on reducing pain, improving movement, and building strength gradually. Your clinician may also discuss activity modification, work changes, and pain relief options. Surgery is used for some tears, particularly distal tears at the elbow or tears that cause major weakness.

When is surgery considered?

Surgery is often considered for a complete distal biceps tendon tear, especially in active people, manual workers, or anyone with significant weakness. It is usually done sooner rather than later. For a long-head tear at the shoulder, surgery is less often needed and may be considered if pain or weakness continues despite physiotherapy.

Living with this condition

You may need to use your other arm more for a while. Avoid sudden lifting, pulling, or reaching overhead. Follow your rehabilitation plan and increase activity slowly. Ask for help with heavy tasks at home or at work.

Lifestyle tips

• Warm up before exercise and increase training gradually
• Use good lifting technique and keep loads close to your body
• Avoid smoking, which can slow healing and weaken tendons
• Maintain a healthy weight and stay generally active
• Set up your workspace to reduce repeated strain

Diet and exercise

Eat balanced meals with enough protein to support muscle and tendon repair. Gentle movement and physiotherapy exercises are important, but avoid heavy loading until your clinician or physiotherapist says it is safe. Build strength step by step rather than rushing back to full activity.

Mental health and emotional wellbeing

It is normal to feel frustrated, worried, or low when an arm injury affects your independence, work, or sport. Talk to your clinician if stress or low mood is building. If you ever have thoughts of harming yourself, contact your local emergency services or a crisis support service right away.

Prevention

Not every biceps tendon tear can be prevented, especially when tendons have worn with age. You can lower your risk by building strength gradually, using good technique, warming up, pacing heavy work, and not smoking.

Vaccines

Not applicable — there is no vaccine for tendon tears.

Screening programmes

There is no routine screening for biceps tendon tears. See a clinician if you have a sudden pop, weakness, or a change in arm shape.

Complications

If left untreated

• Ongoing pain or stiffness
• Lasting weakness when lifting or turning the palm upward
• Difficulty with work, sport, or daily tasks
• A visible bulge or change in arm shape
• A longer recovery or a higher chance of needing surgery later

Long-term outlook

Most people recover useful arm function. Long-head tears at the shoulder often do well with physiotherapy, and distal tears at the elbow generally do well with the right treatment, including surgery when needed. Recovery can take weeks to months, so patience with rehabilitation matters.

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