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Biceps Tendon Rupture

Biceps Tendon Rupture is a complete or partial tear of the long bicipital tendon at a proximal or distal location from repetitive micro trauma or acute traumatic injury.


The mechanism is usually forceful eccentric biceps contraction, and it may be acute or chronic.

The patient has instant pain either in the shoulder and proximal biceps or in the distal biceps. Sometimes there is swelling and ecchymosis.

Patients may feel a pop or snap during the initial stage.

Image shows anatomy of Biceps tendon rupture
Biceps tendon rupture anatomy

Patients might have mild weakness to resisted flexion of the elbow and supination of the forearm if there is a proximal rupture. This may be quite noticeable in a distal rupture.

Biceps Tendon Rupture
Biceps Tendon Rupture


Treatment of biceps ruptures is generally nonoperative with good results, especially in the elderly.

Proximal rupture:

Acute immobilization in posterior elbow splint with the elbow at 90 degrees for comfort and forearm in full supination; add sling for comfort.

Younger patients should begin immediate shoulder and elbow passive range of motion (ROM) exercises.

Strengthening can begin in 4–5 wks or when there is resolution of pain

Patients over 50 yrs of age may require longer period of immobilization prior to strengthening rehab.

Younger patients may prefer surgical treatment (tenodesis) for cosmetic reasons or to return to their previous level of functioning

Most patients are older and will have little to no change in elbow flexion/supination strength; they may opt for surgery, however, if there is additional rotator cuff pathology.


Distal rupture:

Acute management is the same as for proximal injuries.

Most patients require surgical repair because there is more significant loss of elbow flexion and supination strength and endurance with distal injuries