Biceps Tendon Rupture Types and Treatment

Biceps tendon tears or ruptures are often painful and frightening injuries. Although they typically occur in men of middle age or older, these injuries can also happen to younger and elderly individuals. The most common injury occurs when lifting or pulling on a heavy object, particularly when something slips or starts to fall. Most often, a snap or pop is both felt and heard, and pain occurs around the shoulder or elbow, depending on which part of the biceps tendon is torn.

Making the diagnosis of a torn biceps tendon is typically straightforward, but the decision for how to best treat these injuries may be more complicated. Deciding if surgery is necessary, or even helpful, may be more complicated, and the ideal treatment may not be the same for everyone.

The Biceps Tendon and Muscle

The biceps tendon is the structure that connects the biceps muscle to the bone. The biceps muscle helps bend the elbow joint, but it also has other functions. It is important in the motion called supination of the forearm. This is the motion of turning the palm facing upwards, such as when opening a doorknob or turning a screwdriver. The biceps tendon is also important in its contribution to shoulder stability.

There are two proximal biceps tendon attachments at the shoulder joint, and a single distal biceps tendon at the elbow. The reason it is called the biceps ('bi,' meaning two) is that there are two major parts of the muscle. Each of these parts of the muscle belly has its own tendon attachment on top by the shoulder, and the two parts coalesce into one tendon attachment at the elbow.

The long head of the biceps attaches inside the shoulder joint, right on the rim of the shoulder joint socket. The short head of the proximal biceps attaches to a spur of bone in front of the shoulder called the coracoid process.

Types of Biceps Tendon Ruptures

A biceps tendon rupture is an injury that occurs to the biceps tendon attachment causing the tendon to separate from the bone.

A normal biceps tendon is connected strongly to the bone. When the biceps tendon ruptures, this tendon is detached. Following a biceps tendon rupture, the muscle cannot pull on the bone, and certain movements may be weakened and painful.

There are two types of biceps tendon ruptures.

Proximal Biceps Tendon Rupture

A proximal biceps tendon rupture is an injury to the biceps tendon at the shoulder joint. This injury type is the most common type of biceps tendon injury. It is most common in patients over 60 years of age and often causes minimal symptoms.

As stated above, proximal biceps tendon injuries almost always occur to the long head of the biceps tendon. Injuries to the short head of the biceps are essentially unheard of.

Distal Biceps Tendon Rupture

The distal biceps tendon is injured around the elbow joint. This is usually an injury that occurs with heavy lifting or sports in middle-aged men. Many patients with a distal biceps rupture will have surgery to repair the torn tendon.

Treatment Options

Deciding whether to have the biceps tendon repair depends on a number of factors, including the age of the patient, the activity level of the patient, which arm the injury is on (dominant or non-dominant), and the expectations for future.

Biceps tendon injuries are generally repaired in younger, more active patients, or in patients with injuries to the dominant extremity. However, results of non-surgical treatment are not as bad as many people think. There is often some deformity to the shape of the muscle, but usually, the loss of strength is much less than many expect. Nonsurgical treatment is often an option.

You should discuss these treatment options with your orthopedic surgeon, who can help you determine the best option for your situation.​