Proximal Biceps Tendon Rupture

The biceps is a muscle in the upper arm that helps move the shoulder and elbow joints. It has two parts, the short and long heads, which work together. The biceps is connected to the shoulder joint by two tendons, known as the proximal biceps tendons, and to the elbow joint by a single tendon called the distal biceps tendon.

The long head of the biceps tendon connects to the top of the shoulder joint, while the short head attaches to the shoulder blade. If the proximal bicep tendon tears or ruptures, it is called a proximal biceps tendon rupture. This injury usually occurs in the long head tendon and can be either partial or complete.

Causes of a Proximal Biceps Tendon Rupture

Many risk factors can cause a proximal biceps tendon rupture. Some of the most common causes are falling on an outstretched arm, lifting heavy objects, and overusing the shoulder, particularly during overhead activities and sports. Other factors that can increase the risk of this injury include certain medications, aging, and smoking.


If you suspect a proximal biceps tendon rupture, there are several signs and symptoms you can look out for; these include sudden, sharp pain in the shoulder or upper arm, as well as a popping or snapping sound in the shoulder. Tenderness and muscle cramping in the affected area are also common symptoms. Additionally, you may experience weakness in the shoulder and difficulty with movements involving the elbow. Rotating the forearm may also become more challenging.


When diagnosing a proximal biceps tendon rupture, your doctor will review your medical history and current symptoms. They will also assess the strength and movement of your arm. Another symptom that may indicate this type of injury is a “Popeye muscle,” a telltale sign of a complete rupture of the proximal tendon. This occurs when the muscle bunches up at the elbow. In cases of partial ruptures, patients may experience pain when bending the arm.

Treatment Options

The proximal biceps tendon rupture can be associated with other shoulder injuries and disorders like rotator cuff injury. Therefore, the doctor will examine your shoulder and look for additional disorders that can cause further symptoms. Some of these disorders include shoulder instability, shoulder impingement, or a fracture to the humeral head.

Radiology or imaging studies may be necessary to visualize the shoulder joint and make an accurate diagnosis. A doctor may order an MRI to diagnose the degree of the tear to the tendon, ranging from a partial or complete tendon tear. The degree of muscle retraction and the presence or absence of a muscle tear can also be visualized in an MRI. MRI studies can show damage to the rotator cuff as well. CT scans or another diagnostic tool for tendon rupture. X-rays are not an effective method for evaluating tendons but can assess injuries to bones.

In some cases, a proximal biceps tendon rupture can be treated without surgery. However, surgical intervention may be necessary if other structures in the shoulder have also been injured or if the tendon tear is complete. In addition, active individuals often require surgical repair to restore muscle strength. The treatment protocol will typically depend on the injury’s severity and the patient’s lifestyle. For more information about treatment options, the Idaho Shoulder to Hand team can be a great resource.

Non-Surgical Treatment

Several nonsurgical treatment options can yield excellent results. To begin with, avoiding activities that worsen your symptoms and resting are crucial steps in the healing process. Furthermore, using cold packs to reduce inflammation can help promote recovery. Finally, it is also recommended to undergo physical therapy to strengthen both muscles and tendons.

Surgical Treatment

Although surgery is not typically needed for this condition, there are certain situations where it may be necessary. At Idaho Shoulder to Hand, our board certified orthopedic surgeon will assess whether surgical repair is appropriate for your specific case. In the event of a biceps tendon rupture, a biceps tenodesis procedure may be performed, which involves reattaching the upper head of the tendon to the humerus instead of the shoulder. An upper extremity specialist is the best person to determine which surgical option is appropriate for your individual needs based on your medical history and requirements for recovery.

If you are prepared to discuss your proximal biceps tendon rupture with a team of experts, Idaho Shoulder to Hand is at your service. Our Boise based orthopedic surgery team has extensive experience in managing this type of injury and is well-equipped to assist you in achieving a full and swift recovery.

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