The biceps brachaii is a muscle in the upper arm spanning from the shoulder down to the elbow. It’s called the biceps because it is split into two muscle bellies at the upper end that attach in two separate places in the shoulder. It has only one attachment at the elbow. The biceps are primarily responsible for bending the elbow, for example, bringing your fists to your mouth, and supinating the forearm, such as turning a screwdriver. There’s another muscle under the biceps called the brachialis, which provides even more strength bending the elbow.

Usually, an acute tear happens after some form of forceful move or an eccentric contraction, which means the muscle is contracting at the same time it is being lengthened. For example, when you try to catch a heavy object falling over. The biceps can tear at the lower end where there is only one tendon (distal biceps rupture) or at one of the other muscles at the upper end (proximal biceps rupture). The distal biceps rupture is commonly an acute tear and the proximal biceps rupture is more common with wear over time.

Tears of the biceps at the lower end involve reattaching the biceps tendon to the bone where it tore from. Tears of the biceps usually occur at the tendon-bone interface, not in the muscle or tendon itself. The tendon can be repaired back to the bone in a number of ways. Most commonly, it involves anchoring the tendon back to the bone. This is done by attaching it to an anchoring device that is placed into the radius bone, where the tendon was attached previously. Sometimes this is done with one incision in the front of the forearm and other times it is done with two incisions on the front of the forearm and the side of the forearm. The surgery lasts approximately one hour and patients can go home the same day. It is almost always done as an outpatient procedure.

If the tear occurs at the lower end, it is recommended to see a doctor within the first few days, since surgery may be needed soon for optimal outcomes. If the surgery takes place more than three weeks after injury, it can be a much more complicated procedure.

It depends on where the tear is. If the biceps tear is down at the elbow, it typically requires surgery to repair because there is only one spot where the biceps connects to the elbow. The upper biceps muscles sometimes require surgery to repair and depend on other factors, such as patient age, activity level and occupational demands.

Yes, the goal is to allow you to return to full, unrestricted activity, including contact sports and weight lifting.

Yes, a tear of the other muscles in the forearm or certain fractures can appear like biceps injuries initially. It’s important your suspected injury is inspected by a professional and sometimes an MRI maybe need to confirm the injury. A biceps injury may not be seen with an X-ray, although that may typically be a part of the initial diagnostic process. Sometimes, the injury can be diagnosed without imaging.

The upper end of the biceps, or proximal biceps, runs up the humerus and travels right between two rotator cuff muscles. As it enters the shoulder joint and attaches to the upper portion of the glenoid socket of the scapula, it sits directly below the acromion, which is a portion of the scapula. Many patients have bone spurs in the shoulder, which are small sharp edges of the bone. These frequently abrade and shear the tendons of the rotator cuff and lead to rotator cuff tears and injuries. Since the bicep travels right in the same area, it can be subject to the same types of bone spurs and injuries. This frequently leads to having a rotator cuff tear along with a biceps tear. When the biceps are weakened by bone spurs, it can cause further tearing and lead to a more gradual tear of the proximal biceps tendon.

The bone spurs in the shoulder can slowly abraid the biceps tendon, causing it to tear slowly over time. When the upper biceps ruptures, it is usually not from a specific strenuous event. It frequently is a small event or sometimes, even without a known injury occurring over a long time.

Hopefully, after repair of the distal biceps or treatment and recovery from a biceps injury, most patients can return to full physical activity, including golf and tennis, without irritation.

When the upper biceps tendon tears, it usually happens gradually over time. The tendon will bulge in its muscle belly giving the appearance that it’s thicker but shorter than the other side. This is known as a Popeye deformity because it looks like the biceps muscles of the cartoon character, Popeye the Sailor Man. In most cases, the vast majority of people have no significant long-term functional loss although some people notice cramping on occasion. There is no significant loss of elbow flexion except in heavy laborers, such as those who frequently use a screwdriver.

A Popeye deformity refers to when the long tendon of the bicep ruptures causing it to contact and bulge. This leads one arm to look bigger than the other, similar to the cartoon character, Popeye the Sailor man.