Biceps Tendon Tear (Shoulder)

The biceps muscle is in the upper arm and has multiple functions including bending and rotating the elbow and keeping the shoulder stable. There are two shoulder attachments of the biceps, one at the coracoid and one at the glenoid. Injury most commonly occurs to the head that attaches at the glenoid. It is found most easily in its groove below the pectoralis muscle as it attaches to the upper arm (humerus).

Causes & Symptoms

Injuries to the biceps tendon at the shoulder usually occur from chronic wear, while injuries to the biceps tendon at the elbow usually occur when the elbow is forced straight against resistance.

Symptoms of a biceps tendon tear at the shoulder include a “pop”, bruising, pain, an swelling. The pain and swelling often reduces over a week or two though in some people a small bulge may be noticed in the arm after a biceps tendon tear. In those who perform a lot of forearm rotational activities some weakness may be noted.

Evaluation & Treatment

Evaluation begins with a history of the injury, physical examination including special maneuvers, and X-rays to rule out other injuries. An MRI is helpful to distinguish a partial from a complete tear.

Tears of the biceps at the shoulder are most often treated nonsurgically with pain and arm bulging resolving over time. Surgical treatment is considered in those who have painful cramping, are athletes or laborers, or for those who the cosmetic deformity is unacceptable.

Initial treatment includes ice, rest, and anti-inflammatory medications. Surgical fixation is done as an outpatient procedure. Physical therapy is begun post operatively with an anticipated return to full activity at 2-3 months.