Biceps tendon tear


The biceps is a muscle of the upper arm and consists of two muscle parts - the short and the long head. These arise from two different places on the shoulder and combine to form a common muscle belly where the muscle is visible from the outside. This is attached to the spoke, the forearm bone on the thumb side, by a tendon. Tendons are the connective tissue ends of muscles that attach them to the bone. The biceps has three tendons due to its two-part structure.
Basically, a tear can affect all three tendons of the muscle. By far the most frequently affected area is the tendon near the shoulder of the long biceps head (= "long biceps tendon") on the dominant arm (up to 96% of all biceps tendon tears). Tears in the tendon of the short muscle head (= "short biceps tendon") are the rarest injuries, accounting for around 1%. The tendon that connects the muscle belly to the forearm (= "distal / distal tendon") also tears relatively seldom (approx. 3%).


When the biceps tendon ruptures, the function of the muscle varies in severity, depending on the tendon affected. It is mainly responsible for the flexion and the external rotation of the forearm, but also supports the lifting of the arm to the side and forwards as well as the inward rotation of the entire arm. It should be noted that other muscles of the upper and lower arm take over these movements at least partially in the event of a failure and can compensate for the functional impairment caused by the tear.
During the demolition, those affected feel a sudden, stabbing pain. This can last, but is usually not very strong. Swelling and bruising can also occur.
If one of the tendons close to the shoulder is affected, one often sees a displacement of the muscle belly in the direction of the elbow and a dent in the arm above the muscle. The limitation of muscle strength when lifting and turning the forearm is often only slight because the other biceps tendon can compensate for the corresponding movements. This often means that the symptoms are still mild at the beginning and those affected do not see the doctor until late.
If the distal tendon tears, the only connection between the muscle and the forearm is lost. This means that no more force can be transferred to the forearm and there are severe functional restrictions of up to 60% when lifting and turning the forearm outwards. In addition, a displacement of the muscle belly towards the shoulder and a bulge formation can be observed when there is tension.

Pain from a biceps tendon tear

If the biceps tendon tears near the point of insertion at the shoulder joint (proximal part), this tear is generally associated with little pain. However, non-specific shoulder pain can occur. In addition, there is often tenderness to pressure in the intertubercular sulcus. The sulcus intertubercularis is a groove on the upper arm in which the long biceps tendon runs. If the biceps tendon tears in the area of ​​the insertion on the elbow (distal part), acute stabbing pain usually occurs, which is accompanied by a weakness in the elbow flexion.

Appointment with a shoulder specialist

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Who am I?
My name is Carmen Heinz. I am a specialist in orthopedics and trauma surgery in the specialist team of .

The shoulder joint is one of the most complicated joints in the human body.

The treatment of the shoulder (rotator cuff, impingement syndrome, calcified shoulder (tendinosis calcarea, biceps tendon, etc.) therefore requires a lot of experience.
I treat a wide variety of shoulder diseases in a conservative way.
The aim of any therapy is treatment with full recovery without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Bruising from a biceps tendon tear

The tear in the tendon can result in a bruise (hematoma). After the tendon rupture, this usually becomes clear after a very short time and can also be felt as a hard swelling in the area of ​​the tear. The bruise is also often painful to touch or pressure. A hematoma occurs more often when the distal tendon near the elbow tears.


There are several options to choose from for treating a biceps tendon tear. When deciding on the final therapy, the doctor mainly depends on the affected tendon, the age of the patient and the existing limitation. However, cosmetic changes can also be decisive for the decision to have an operation.
If the long biceps tendon is affected, it must be decided whether an operation is necessary or not.

Conservative therapy

Older people, who continue to cope with their everyday life with a slight reduction in strength of the biceps and who can accept the changed appearance of the upper arm, are typically treated conservatively, i.e. without surgical procedure, due to the increased surgical risks with age. The upper arm is immobilized in a bandage for about 6 days and then a slow build-up of movement is carried out. The permanent loss of strength when lifting and turning the forearm is usually only slight (up to 20%).

Operative therapy

For younger people and athletes, however, an operation should be carried out that almost completely restores the original level of strength. During the operation, an incision is made in the front of the shoulder and the tendon is exposed. It is then either attached to the humerus (partly with the help of drill channels) or to the short biceps tendon. Only in a few cases is the torn tendon long enough to reattach it to the shoulder. Sometimes it may be necessary to remove the remainder of the shoulder (e.g. after clamping) in an arthroscopy.
In the event of a rupture of the distal tendon, due to the severe restriction in flexion and external rotation of the forearm, which would largely remain without surgery, an operative approach is practically always chosen. A small incision is made in the crook of the arm and the torn tendon is found. It is then fixed to the spoke as stably as possible. This can be done directly via a suture on the bone or via stabilizing anchors. If the operation is performed on a tendon rupture that has been around for weeks, the tendon of another, less important muscle may need to be transplanted.
Typically, operations on the biceps tendons are performed under general anesthesia. Local anesthesia of the nerve plexus of the arm can also be performed to relieve pain. This takes place in the neck because the nerves pull from there to the arm. A drain, i.e. a tube with a collecting vessel at the outer end, is often placed in the wound. It serves to drain off the resulting wound fluid and thus to reduce swelling in the operated area. Read more on the topic: Post-op swelling
The discharge from the hospital takes place approximately two days after the operation. The arm must be spared, but it must also be exercised early on. It is important that physiotherapy is started a few days after the operation at the latest. In this way, permanent restrictions of movement in the elbow and shoulder joints can be prevented. Exercise without straining the arm can be started after approx. Four weeks, greater exertion after 12 weeks at the earliest. In the case of occupational activities with heavy strain on the arm, an inability to work of at least three months must be expected.
In addition to the typical surgical risks such as bleeding, injuries to the soft tissue or nerves and infections, the fixation of the tendon on the arm may not be strong enough and may come loose. This can make another operation necessary. If the radial nerve running in the surgical area is injured when the distal tendon ruptures, the fingers and thumb may be weak (usually only temporary).

Exercises for a biceps tendon tear

Exercises should be used to maintain the mobility of the arm and to strengthen and train the remaining muscles. It should be noted, however, that after a biceps tendon rupture near the shoulder, no exercises should be performed for at least one week and after a tendon rupture near the elbow, but that a rest period should be observed. After the rest, strengthening and stretching exercises can be performed.
To stretch the biceps, for example, the hands can be brought together behind the back with the palms facing the floor. In this position, the arms are stretched upwards until a stretch can be felt in the biceps. For strengthening, the arms are stretched out to the side at shoulder level and raised over the head in the stretched state and then lowered back to shoulder level. In the beginning, the exercise should be repeated 15 times and increased over time. The exercise can gradually be supplemented with weights.
To maintain mobility in the shoulder joint, circular movements of the shoulders and arms can be performed. The exercise is performed standing up with the arms hanging next to the body. To train the distal biceps tendon, do elbow flexion exercises and forearm rotation exercises.
Sports such as yoga and Pilates are also beneficial for strengthening, stretching and mobility in the arm and can support faster healing.


After the operation, you have to expect only a slight reduction in strength, especially when lifting and turning the forearm outwards.
After conservative therapy, the loss of strength is usually somewhat greater, but is compensated for by other muscles and allows a normal everyday routine.

How long does it take to heal a biceps tendon tear?

The time it takes to completely heal varies and depends on various factors. The form of therapy, whether a complete or partial tear of the biceps tendon, and the patient's cooperation determine the healing time. Therefore, the therapy can take several weeks to even months. After surgical therapy, the arm must be spared for three to four weeks until it can be loaded again. During this time, however, physiotherapy and exercises should be carried out under supervision. If the arm is loaded too early, this can significantly delay the healing process. After that, several weeks of building exercises should be expected.
If no surgical therapy is necessary, the arm should still be spared for at least a week. After the closed season, it is very important to do physiotherapy and home exercises.


The long biceps tendon usually tears as a result of wear and tear even under low loads. Often, even minor traumas, such as those that occur when lifting a medium-weight object or when exercising lightly, are sufficient to tear the already damaged tendon. In contrast to the other biceps tendons, the long biceps tendon runs inside the shoulder joint. There, various factors (such as tightness due to swellings, bony outgrowths, pre-existing injuries, etc.) can promote wear and tear. In addition, the tendon runs in a bone channel on the upper arm, in which the tendon can be “chafed”. The wear and tear is particularly pronounced in older people and (former) athletes, in whom the tendon is heavily used for years (weight training, throwing sports).
On the contrary, the distal tendon usually tears as a result of trauma in which the muscle is stressed or overstretched while the arm is flexed and twisted outwards and the tendon is therefore taut. Examples of situations are lifting or catching or pulling heavy objects or falling from great heights. Muscle strong, young men are often affected. Strength athletes who use steroids are at increased risk of such a rupture. In a few cases, a blow to the tendon or a cut is the cause.
The short biceps tendon tears mostly due to accidents.