Biceps tendon rupture – all you need to know

Biceps tendon tears can be really painful and stop you living life as normal. Here’s what to do about them.

What are the symptoms?

Causes and risk factors

When to see a doctor

Self-care tips for biceps tendon tears

Diagnosing biceps tendon tears

How is it treated?

From severe pain to bruising and swelling, a biceps tendon rupture can be due to an injury or force, such as lifting a heavy object. The word ‘rupture’ means to have completely torn your biceps tendon, which means it’s come away from the bone fully, but it’s possible to tear it partially, too. Find out more.

Your biceps muscle is at the front of your upper arm. It's attached to the bones in your shoulder and your elbow by biceps tendons, which are strong cords of fibrous tissue.

A healthy biceps tendon allows you to bend at your elbow and twist your forearm, but when you tear it (either partially or completely) these movements become much harder.

A tear can happen at either the elbow or the shoulder but 90% occur at the shoulder.

Here’s how to spot the signs, and when to see a doctor.

## What are the symptoms?

Biceps tendon tears can look and feel different, depending on which tendon is torn. Signs to watch out for include:

- sudden, severe pain at your shoulder or elbow – made worse if you try to lift or pull something
- tenderness in the shoulder or elbow
- a snap or popping sound at the time of injury
- a loss in strength of the affected arm, or weakness
- a deformed ‘Popeye’ muscle in your arm – it will look like a bulge in your upper arm
- bruising and swelling at the front of your elbow, forearm, and upper arm.


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## Causes and risk factors

The most common reason for tearing a biceps tendon is a sudden injury or a forceful event, like lifting a heavy object, falling on an overstretched arm, or twisting your elbow.

It means the injury can happen to anyone, but you’re more likely to tear your biceps tendon if you:

- __overuse your muscles without enough rest__ – such as using the same muscles repeatedly in exercises like weightlifting
- __are older__ – wear and tear that comes with years of use can make older people more susceptible
- __smoke__ – this can affect the strength and quality of tendons
- __take corticosteroids or anabolic steroids__ – they’re linked to muscle and tendon weakness
- __take certain antibiotics__ – such as fluoroquinolones. 

## When to see a doctor

Book an appointment with a doctor if you have pain in your arm and:

- it’s severe
- you notice less range of motion at your shoulder or elbow
- you have a bulge (Popeye) muscle in your upper arm.

## Self-care tips for biceps tendon tears

If you have a partial tear and your symptoms are mild, try managing them with self-care, such as: 

- __icing the area to minimize swelling and pain__ – use a bag of frozen peas wrapped in a towel for 15 to 20 minutes at a time, as often as possible during the first 24 to 48 hours
- __using painkillers__ – such as nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, to reduce pain and inflammation. Check with a doctor or pharmacist if it’s safe for you to take these
- __resting your arm from all activities__ – you could also use a sling to minimize movement, prevent further injury, and speed up the healing process.

## Diagnosing biceps tendon tears

At your doctor’s appointment, you’ll be asked detailed questions about your symptoms and how the injury happened.

Your doctor will also take a look at your arm and run you through a physical exam, which might include:

- feeling the front of your elbow
- asking you to bend your arm and tense your biceps muscle
- asking you to rotate your forearm
- comparing the strength of both of your arms.

A complete tear of your biceps tendon (a rupture) at the shoulder will be the obvious diagnosis if you have a Popeye muscle in your upper arm.

For partial tears at the shoulder and tears (partial or complete) at the elbow, you might need further tests. These could include:

- __an X-ray__ – useful in ruling out other causes of elbow or shoulder pain
- __an ultrasound scan__ – can reveal the affected biceps tendon in more detail. Ultrasounds are better for examining shoulder issues, and less effective for tears at the elbow
- __a magnetic resonance imaging (MRI) scan__ – often used to confirm a diagnosis, but may not be needed. MRIs offer images of soft tissue to show both partial and complete tears of the biceps tendon.

## How is it treated?

In most cases, symptoms of a biceps tendon tear go away over time. If your tear is not severe then [self-care](https://www.livehealthily.com/health-library/conditions/bicep-tendon-rupture#selfcare) may be enough to help.

Physical therapy exercises can also get your arm back to its normal range of movement. 

In more severe cases, surgery may benefit you, including if:

- you’re getting severe cramping in the muscle
- you’ve ruptured your biceps tendon at the elbow
- other structures in your shoulder, such as your rotator cuff, have also been damaged
- you’re getting shoulder pain
- you need to get full strength and movement back in your arm, such as if you’re an athlete or manual laborer
- your symptoms haven’t improved with self-care or nonsurgical treatment.

There are several types of surgery to help repair the tendon – your healthcare professional can discuss what’s best for you.

Rehabilitation after your procedure, including wearing a sling and physical therapy exercises, can help restore strength and flexibility to your arm. It’s a slow process, but make sure to keep following the treatment plan given to you by your doctor.

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References

Amelia Glean

Fiona Bugler

Dr Ewan O'Farrell

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