The biceps muscle in your upper arm originates from your shoulder blade and inserts along the forearm bones just below your elbow. This muscle flexes your elbow, enables you to rotate your forearm, and helps raise your outstretched arm forward at the shoulder. Excessive strain on your biceps muscle can lead to a partial or complete tear of the associated tendons at the shoulder or, less commonly, at the elbow. Treatment depends on the cause, location and extent of the tear as well as your age, occupation and activities.
Tear at the Shoulder
Most biceps tendon occur at the shoulder and involve the long head of the muscle, which crosses across the front of the shoulder. Even with a complete tear of the long head of the biceps, the muscle retains most of its strength because it is still attached to the shoulder blade via the short head of the muscle, which almost never tears. For this reason, treatment might not involve surgical repair.
Nonsurgical treatment, also known as conservative therapy, typically involves:
- Icing with cold packs at 20-minute intervals
- Nonsteroidal anti-inflammatory medication, such as ibuprofen (Advil, Motrin) or naproxen (Aleve)
- Resting the injured arm
These measures are usually followed by physical therapy to help regain shoulder strength and flexibility.
People who require near-normal upper arm and shoulder strength -- including athletes and those whose occupation requires such strength -- and persons who experience ongoing discomfort from a long head of the biceps rupture typically undergo surgical repair of the torn tendon.
Physical therapy is employed after a period of postoperative healing. The goal is to restore function of the muscle to near-normal, enabling you to return to all of your previous activities.
Tear at the Elbow
Although biceps tears at the elbow are less common than shoulder tears, they are generally more serious in terms of loss of muscle and arm function at the elbow joint. For this reason, early surgical repair -- within 2 to 3 weeks of the injury -- is usually recommended for complete biceps tears at the elbow. This is followed by extensive physical therapy after a period of postoperative rest. Full restoration of strength and function can be attained in most people, particularly when the injury involves the dominant arm.
For a partial biceps tear at the elbow, conservative treatment is sometimes recommended for older patients if a significant reduction in biceps strength and endurance is acceptable. The loss of strength is typically 35 to 50 percent, according to "Wheeless' Textbook of Orthopedics." Some people find this option more acceptable if the injury involves the nondominant arm. Nonsurgical treatment for partial tears at the elbow is similar to that employed for biceps tears at the shoulder.
Signs, Symptoms and Next Steps
Biceps tendon tears at the shoulder most often develop gradually with progressive fraying of the tissue. This frequently occurs due to ongoing overuse, such as with an occupation that requires overhead lifting or athletic pursuits like swimming or tennis. Signs and symptoms include upper arm pain or cramps with repeated use, biceps weakness, difficulty rotating the arm and a new bulge in the biceps.
Biceps tendon tears at the elbow usually occur suddenly with a popping sensation followed by pain, swelling and bruising near the elbow as well as weakness and a new bulge in the biceps.
Because biceps tendon tears require medical evaluation and treatment, see your doctor as soon as possible if you suspect you might have this type of injury.
Reviewed and revised by: Tina M. St. John, M.D.