Biceps Tendon Injury

A biceps tendon injury can occur as a result of overuse or severe injury. While biceps tendon tears are not as common as others, there is no way for the body to achieve distal biceps repair on its own when the torn tendon reaches the elbow. This type of tendon tear usually requires surgery to repair any distal biceps tendon rupture and to regain full strength in the shoulder joint and function of the biceps muscle. However, this procedure should be performed within a few days of the tendon ruptures.

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Patients who suffer a torn biceps tendon injury will often hear a small “pop” and notice a sudden sharp pain near the elbow. Additional symptoms may include:

  • Swelling and bruising near the elbow
  • Difficulty twisting and bending the arm
  • A noticeable bulge in the upper arm from the recoiled muscle
  • Shoulder pain

Bicep Tendon Repair Surgery

Distal biceps tendon injuries typically require surgical treatment to restore your full range of motion and strength to the elbow.  Depending on the extent of the damage, different surgical approaches may be used. Dr. Goldberg can help assess and determine the best treatment options for you, and if you might be a candidate for tendon repair surgery.

What is a Biceps Tendon Injury and How is it Fixed?

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What is a Biceps Tendon Injury and How is it Fixed?

The biceps are essential in flexing the elbow and supinating the forearm. A rupture of the biceps tendon occurs proximally near the shoulder or distally near the elbow. These ruptures mainly occur when the elbow is flexed suddenly or forcefully. Some people might hear a “pop” sound when it happens as the tendon separates from the bone and there may…



Recovery after surgery often depends on the size and severity of the injury and the patient’s overall health. After the procedure, the elbow will be placed in a splint that enables the use of the hand. Most patients are able to perform daily activities such as dressing, eating, writing, and driving within a few days. Some discomfort, pain, and limited mobility should be expected a few weeks after surgery.

Dr. Goldberg’s practice recommends an accelerated rehab protocol that encourages patients to perform specific exercises the first day after surgery and start physical therapy within a week of their operation.

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Do I need surgery for torn biceps?

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.

What is the surgery for torn biceps?

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.

How long does it take to recover from biceps surgery?

Depending on the method of fixation, frequently patients are able to move their arms after 1 to 4 weeks after surgery. However, doctors may have the patients refrain from sports or strenuous activities for up to three months after, depending on the doctor's preference. Typically, we let our patients go back to full activities about two months after surgery.

Why do my biceps look different on one side than the other?

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.

Can I return to sports after biceps surgery?

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

My doctor said I tore my rotator cuff and biceps. How did I tear both?

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.

What are the biceps and what does it do?

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.

How do I know if I tore my biceps?

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.

How quickly do I need to see a doctor for torn biceps?

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.

How did I tear my biceps if I'm not a professional athlete?

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.

What sports can I do after biceps surgery?

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.

What is a Popeye deformity?

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.

Are there other conditions that can mimic a biceps injury?

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.