Biceps Tendon Rupture. A complete guide for understanding symptoms, causes, diagnosis, treatment, and physiotherapy

What Is the Biceps Muscle?

The biceps muscle is located at the front of the upper arm. It has two parts (heads) and is responsible mainly for:

• Bending the elbow

• Rotating the forearm (turning the palm up)

• Assisting with lifting and stabilising the shoulder

The biceps also helps stabilise the shoulder joint, especially during lifting and pulling movements.

In over 90% of cases, the injury affects the long head of the biceps near the shoulder. Less commonly, the tear happens near the elbow (distal attachment) or involves the short head near the shoulder.

Why Does a Biceps Tear Happen?

A biceps tear usually occurs due to:

• Sudden heavy load

• Strong eccentric contraction (the muscle is stretched while contracting)

• A sudden pull or jerk

Risk factors that significantly increase the chance of tearing include:

• Poor or no warm-up

• Dehydration

• Use of anabolic steroids

• Mineral deficiencies

• Incorrect exercise technique

• Poor recovery between workouts

• Previous untreated injuries of the musculoskeletal system

⚠️ This injury is not limited to athletes. It can happen during a single intense effort outside the gym, especially when lifting without warming up.

Symptoms – How to Recognise a Biceps Tear

At the moment of injury, people often experience:

• A sudden snapping or popping sound

• Immediate sharp pain

Over time:

• Sharp pain changes into a deep, dull ache

• A bruise may appear within hours (but not always)

• The biceps muscle may look shortened or misshapen (“Popeye sign”)

Depending on where the tear occurs:

• The muscle belly may move toward the remaining attachment

• In some elbow-side tears, this visible deformity may not appear because a connective tissue layer still holds the tendon in place

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Diagnosis

During physical examination, there is usually:

• Weakness in elbow bending

• Weakness in forearm rotation

For tears near the elbow, a special clinical test called the Hook Test is very reliable.

Imaging:

• Ultrasound is commonly used

• MRI is used when the diagnosis is uncertain and gives a definitive answer

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What Happens If You Don’t Have Surgery?

For people who:

• Are not strength athletes

• Do not mind cosmetic changes

• Do not need full arm strength for work or sport

…non-surgical treatment may be considered.

Studies show that without surgery:

• Elbow bending strength may recover to 70–88%

• Forearm rotation strength to 60–75%

This is because the biceps is mainly a supporting muscle. The main elbow flexor is another muscle, so everyday function is often acceptable.However, many patients report faster fatigue of the injured arm.

Surgical Treatment

Surgery is usually recommended for:

• Active individuals

• Strength athletes

• Manual workers

• Distal (elbow-side) biceps tears

⏱️ Timing mattersThe best results are achieved when surgery is performed within 2 weeks after injury. Delaying surgery:

• Makes the operation more difficult

• Prolongs rehabilitation

• Increases the risk of nerve irritation (usually temporary)

Surgical techniques vary and may include:

• Endoscopic repair (partial tears)

• Single or double incision surgery

• Fixation using sutures, screws, or bone tunnels

The exact method depends on the surgeon’s experience, available equipment, and the patient’s condition.

Physiotherapy After Biceps Tear Surgery

Physiotherapy should begin as early as possible after surgery.

Early stage focuses on:

• Wrist and finger exercises

• Gentle shoulder movement

• Pain-limited range of motion

Elbow exercises are introduced gradually after a few days.The most restricted movement is usually forearm rotation.

A physiotherapist carefully decides:

• When to increase load

• How much pain is acceptable

• How to progressively stress the tendon

This is crucial because only gradual loading allows proper tendon healing.

Rehabilitation includes:

• Open and closed chain exercises

• Strength, mobility, and control training

Additional techniques may include:

• Deep tissue massage

• Fascial therapy

• Trigger point therapy

• Kinesiology taping

• Flossing

• Dry needling

• Scar therapy

• Joint mobilisation

All of these aim to restore:

• Full range of motion

• Blood supply

• Tendon strength and endurance

🚫 Excessive use of anti-inflammatory medication is discouraged, as inflammation is necessary for proper tissue healing.

Prevention – How to Reduce the Risk

Key prevention strategies include:

• Proper warm-up

• Adequate hydration

• Maintaining muscle flexibility

A sedentary lifestyle keeps the elbow bent for long periods, which may lead to biceps shortening and increase injury risk.

In the gym, one of the most common causes of biceps tears is the deadlift with a mixed grip. To reduce risk:

• Avoid mixed grip when possible

• Maintain constant triceps tension

• Use loads appropriate to your ability

  
  

When to See an Orthopaedic Doctor

You should seek professional assessment if you experience:

• Sudden arm pain after lifting

• A popping sensation in the arm or shoulder

• Visible change in biceps shape

• Persistent weakness after injury

  
  

Early diagnosis and correct rehabilitation make a huge difference in recovery.

References

1. Alentorn-Geli E. et al. Distal biceps tendon injuries. EFORT Open Reviews, 2016.

2. El-Hawary R. et al. Distal biceps tendon repair techniques. Journal of Hand Injury, 2003.

3. Athwal G.S. et al. Clinical anatomy of the distal biceps tendon. Journal of Hand Injury, 2007.