Ask the Expert: Bicep Tears

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In this week’s installment of Ask the Expert, Dr. Frank Cordasco, Orthopedic Surgeon, answers questions on bicep tears.

Q1. What is a bicep tear?

The biceps muscle is a bipennate muscle (two muscle bellies). The two components are called the short head and the long head. Each muscle has an associated tendon. The end of the muscle closer to the elbow generally has a convergence of the two muscle bellies and has one tendon called the distal biceps tendon. The end of the muscle closer to the shoulder has two discrete tendons called the short head biceps tendon and the long head biceps tendon.

When an athlete or patient sustains an injury or in the absence of injury develops persistent symptoms, they should seek medical attention from a fellowship trained sports medicine specialist. While the diagnosis can often be made based upon the history and clinical exam, an MRI is often obtained to analyze the injury completely.

Q2. How and where do bicep tears occur? Who’s at risk?

Each of these three tendons can tear. Of the three tendons, the long head biceps tendon near the shoulder is the more commonly torn, next is the distal biceps tendon near the elbow and the short head biceps tendon near the shoulder is rarely torn.

The long head biceps tendon can tear without trauma in patients older than 45 and this usually occurs in conjunction with rotator cuff tendon tears. These tears are often life-related, associated with more of a degenerative process and can occur in males and females.

In the younger active population or athletes the long head biceps tendon can tear secondary to trauma (such as lifting a heavy box or at the time of a fall on an outstretched arm) or sports. In sports these injuries are often related to Biceps Labral Complex tears associated with the attachment site within the shoulder joint. These injuries can occur in throwing athletes, elite swimmers, athletes involved in collision sports or weight trainers. These tears are sustained in both males and females.

The distal biceps tendon tears occur in younger patients often associated with trauma and in athletes engaged in weight training and collision sports. Occasionally, these tears are sustained in older patients who attempt to for example, open a window that is stuck. It should be noted that there is a gender specific difference in that most of these Distal Biceps Tendon tears occur in males.

Q3. What are the treatment options for torn biceps?

In general, distal biceps tendon tears should be treated with surgical repair in most active healthy patients. Athletes that I have treated surgically include a NFL Offensive Lineman, a collegiate wrestler, an Olympic power lifter, an elite extreme sports athlete and several older (40-50 years of age) weight-training enthusiasts.

Long head biceps tendon tears should be evaluated carefully to determine whether it is an isolated long head biceps tendon tear or combined with an associated rotator cuff tendon tear or a biceps labral complex tear. This typically will require an MRI for a thorough analysis. Treatment is predicated upon the results. Isolated Long Head Biceps Tendon tears are sometimes treated non-operatively in older, lower demand patients. Younger patients and athletes will benefit from surgical repair that is termed a tenodesis in which the tendon is reattached in an appropriate location to restore function and secondarily to improve cosmesis. Combined injuries that include rotator cuff tendon tears and/or biceps labral complex injuries generally require surgery for a satisfactory outcome with respect to pain relief and return to activity.

Q4. What is the recommended time to return to full activity?

When surgery has been recommended, the athlete should seek consultation from a fellowship trained (in sports medicine or shoulder and elbow surgery) orthopedic surgeon.

These repairs typically require several months for the athlete to get back to their prior level of sports activity. There is a period of biologic healing with certain restrictions during the first 4 weeks following surgery. Progressive range of motion begins in the second month with early strength and conditioning beginning after 10-12 weeks.

Dr. Frank Cordasco is an Orthopedic Surgeon in the Sports Medicine and Shoulder Service at Hospital for Special Surgery. The primary focus of Dr. Cordasco’s practice includes ACL and meniscus injury in the pediatric, adolescent, and adult athlete; shoulder instability; bicep tendon tears, rotator cuff and pectoralis tendon repairs, clavicle fracture surgery and AC joint separations. Dr. Cordasco’s research and education activities parallel and complement these clinical areas of expertise.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


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  1. Iโ€™m 44 years old and I tore my long head bicep from the shoulder 2 years and a half ago. At the time, the Orthopedic Dr. said I did not need to repair it due to my work and lifestyle. However, I keep regretting the fact that I did not have it fixed as I canโ€™t get over the cosmetic aspects of it. I know I should have gotten a second opinion. Can I still have this fixed after this long?

    1. I’m 24 years old and I had a ruptured the distal bicep muscle belly. I suffered this injury exactly 2 months ago when arm was caught in a piece of machinery and it basically peeled back the inside portion of my bicep upwards of my arm. I’ve noticed little atrophy but the muscle just hangs inward. it will still flex but curls up into a ball. When rested or held at 90 degrees very unnoticeable except for the hanging inward of what was torn. I suffer from pain of doing normal things around the house like picking up a small laundry basket of maybe 15 lbs or closing a door. Is this operable still due to time. i am still very young and very dedicated to a year or more of therapy to have my life back. Im even open to experimental drugs for healing if it would help. I’ve had no choice but to rest it mostly. what are your thoughts. any and all specialist or orthopedic advice welcomed.

      1. Hi Tyler — The best approach at this time is to see a dedicated Orthopaedic sports medicine surgeon with an expertise in this area. Surgery is generally the only method of definitive treatment. Drugs (experimental or otherwise) without surgery are not effective.

    2. Hi Larry — I would suggest that you have a consultation with an Orthopaedic Surgeon who has an expertise in sports medicine and shoulder surgery. Chronic long head biceps tendon tears can be reconstructed. A history, careful physical exam and up to date imaging in the form of X-rays and MRI would be useful to be certain of the diagnosis (isolated long head biceps tear versus one associated with a rotator cuff tear).

  2. I had a long head torn bicep for a little over 2 years. At the time, the Dr. suggested no surgery since I have a desk job. Although, I’m very active outside of work, my arm seems like it’s getting weaker and cramping since I cannot lift on it as much as I used to. Is there still any options to repair it?

    1. Hi Ruben — I would suggest to follow-up with a sports medicine shoulder specialist to determine the precise details of the tear (is it an isolated Long Head Biceps tear or has their been progression to include the rotator cuff tendons?). Surgical intervention may be beneficial based upon the results of a thorough history, physical exam and likely additional up to date imaging.

    1. Hi Richard, if repair of the long head of the biceps tendon is indicated it is always best to perform the repair sooner than later. Having said that, repair of a chronic long head biceps tendon tear is possible. This involves a relocation of the tendon to a location on the humerus (bone in the upper arm) which is termed a tenodesis. The procedure generally can improve pain and muscle spasm, however the cosmetic result is less predictable as it relates to symmetry with the opposite side.

  3. I have a torn long head of my right bicep. The surgeon I talked with said there is nothing he can do. My question is: if someone’s heart can be moved from one person to another, or a liver or lung be transplanted, then why is it so hard to reconnect a muscle? Just trying to make sense of his response…I have been active all my life and now I”m just supposed to quit because he doesn’t want to help me? should I get a second opinion?

    1. Hi Stephen, thank you for reaching out. Dr. Samuel Taylor, Orthopedic Surgeon, says: “It is true that science has seen many amazing advances in recent decades. Can we perform an operation to fix a ruptured long head of the biceps tendon? Yes. Is this the right thing to do? Sometimes, but not often. The long head of the bicep tendon contributes approximately 10% of the power generated by the biceps muscle. The long head of the biceps tendon can be affected by a number of lesions which can result in pain and sometimes progressive tearing of the tendon. Rupture of the tendon is not uncommon and often relieves pain. In fact, tenotomy (surgical release) of the long head of the biceps tendon is a well accepted treatment for patients with long standing biceps tendinitis. The majority of patients have no functional deficit after rupture of this tendon and return fully to their activities. While we ultimately make decisions based on individual patients, it is safe to say that in general, operations are only performed for ruptured long head of the biceps tendon in patients who have persistent symptoms.” If you wish to seek consultation at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  4. I went to my Dr. about my bicep tear. I heard the popping sound then pain. My arm was sore but got better. Then when I was reaching for something up high and tried to left it it hurt again in the middle of my bicep. When I got hope I noticed a bruise, I made a Dr.’s appt but looked up on internet and thought it would be a short head bicep tear because it hurts at the inside of shoulder. Dr said it was distal bicep tear and they do not operate on women especially one 61 years old. I am still very active and felt violated by her. Is this the case with all women? I have insurance I do not understand this. Why can’t women get this operation?

    1. Hi Lynette, thank you for reaching out. Dr. Samuel Taylor, Orthopedic Surgeon, says: “You need to get clarity regarding whether this is a proximal (by the shoulder) or distal (by the elbow) biceps tendon tear as the two are treated very differently. Proximal biceps tears are almost exclusively of the long head of the biceps tendon. Distal biceps tears, however, may be treated more aggressively from a surgical standpoint and are done so in an expedient manner for both men and women.” If you wish to seek a consultation at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  5. I think I tore the short-head biceps tendon. I’m actually waiting to get an appointment to see my Dr and I don’t see any info about it online, other than “they rarely tear” which I’ve seen from multiple sources. And no info on how to treat it or surgery to repair it, which is kind of weird. Based on the location of the injury, my deformed bicep (opposite from the pictures I see) and the pop/snap noise I heard when it happened, I’m thinking it was the short-head. Anyway, you probably won’t see this but I figured I’d try sending it. Thanks, Jeff.

    1. Hi Jeff, thank you for reaching out. Dr. Samuel Taylor, Orthopedic Surgeon, says: “Tearing the short head of the biceps would be an extremely uncommon injury. If the pain, swelling, and bruising is in the front of the shoulder and then the more likely scenario is that the long head of the bicep tendon tore. Alternatively, you may have torn the biceps tendon where it attaches near the elbow, called the ‘distal biceps,’ which can produce a deformity opposite the one in the picture, termed a “reverse Popeye sign.” If you tore the distal biceps, you would most likely benefit from surgery, and sooner rather than later.” It would be best for you to consult with a physician so that they can determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.