Biceps Tendon Rupture and Advances in Surgical Treatment

Have you felt a pop in your arm and been concerned that you may have torn your biceps?  You are not alone – this common injury affects thousands of Americans every day, with the typical tear occurring in males 30-50 years old, often with a distinct tearing feeling or even an audible “pop”.

These tears often cause significant bruising and loss of function and tend to do poorly without surgical reattachment of the torn tendon. Fortunately, there have been significant advances in the understanding of the tear and proper repair within the last couple of years that not only allows for a significantly stronger repair, but also allows for earlier recovery through minimally invasive treatments.

What is a biceps tear?

It is important to understand a bit of anatomy before delving into the specifics of the biceps tear rupture specifics.  The biceps tendon has two attachments at the shoulder and one attachment at the elbow. The biceps tendon is not only important for elbow flexion, but also forearm supinaton –rotation of the forearm that allows us to open up a door or hold our hand out for change. Rupture of the biceps tendon at the shoulder or elbow will cause dysfunction in both functions.

Proximal Biceps Tendon Rupture

The typical injury to the upper end of the biceps is where the biceps tendon ruptures from its attachment at the shoulder joint, specifically at the superior labrum of the glenoid bone.  Typical symptoms include shoulder pain, bruising, and often a bulging, shortened biceps muscle known as a “Popeye muscle.”

Often patients who tear their biceps tendon describe preexisting pain at the front of the shoulder and pain with shoulder movement called biceps tendonitis.  Biceps tendonitis can often be prophylactically treated to prevent or minimize biceps rupture, often through physical therapy, steroid injections or shoulder arthroscopy to debride or repair the tendon.

With Proximal Biceps tendon rupture, many active patients notice a slight loss of strength and a significant cosmetic change in their arm with the bulging muscle and many benefit from repair. I perform the proximal biceps tendon repair as an outpatient procedure and is often quite successful, typically allowing for full return to previous activity.

Distal Biceps Tendon Rupture

Injury to the distal biceps occurs when the biceps tendon is being flexed against a significant force. There is typically a “pop” or a tearing sensation followed by bruising and retraction of the biceps muscle. In a significant percentage of patients, this initial episode is followed by a reasonable return to activity over the next several weeks, delaying care.

Active patients often notice pain, weakness and difficulty in twisting activities such as opening a door. Elbow flexion is somewhat preserved due to the presence of the brachialis muscle, which is quite strong and rarely injured.

Treatment for distal biceps tendon rupture includes prompt early diagnosis as the retracted muscle and tendon quickly scars into its retracted position. For the vast majority of patients, surgical reattachment is recommended and can be done as an outpatient procedure.

New Repair Treatment Technique

I perform a newer technique of Biceps Tendon repair, which includes performing the surgery through a very small incision, typically 2 centimeters at the elbow. The smaller incision is utilized due to a newer biceps button technique that provides not only stronger fixation and proper tension, but also earlier recovery due to the strength of the repair and the limited nature of the incision and dissection.

Chronic biceps tendon ruptures (typically over 3 months old) might require larger dissection, due to the retracted scarred nature of the tear.  They can occasionally require the use of additional tendon graft, but still utilize newer more-reliable fixation techniques that allow for quicker rehabilitation.

All in all, advances in Biceps tendon tear repair allows for early return to activity and strength. The key to proper treatment includes early identification and diagnosis and is quite rewarding to help patients return to their pre-injury state of function.
Do not hesitate to contact us for further questions or for a prompt evaluation.


About Scott D. Ruhlman

Scott D. Ruhlman, MD Dr. Ruhlman offers the highest quality specialty care of hand, shoulder and elbow disorders. In addition to caring for such disorders in both the child and the adult, Dr. Ruhlman offer state-of-the-art fracture care, sports medicine and joint replacement surgery of both the upper and lower extremities.