Proximal Biceps Tendon Tear

shoulder pain
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The biceps tendon connects the biceps muscle to the bone.  Below the biceps muscle is the distal biceps tendon that attaches to the bone at the elbow.  Above the biceps muscle is the proximal biceps tendon that attaches to the shoulder.  The proximal biceps tendon has two parts, the long head and the short head--almost all injuries to the proximal biceps are to the long head of the tendon.

The long head of the biceps tendon attaches inside the shoulder joint, just above the socket of the shoulder joint.

   The tendon actually attaches to the rim of cartilage that surrounds the shoulder socket called the labrum

Rupture of the Proximal Biceps Tendon

Rupture of the proximal head of the biceps tendon involves one of long head of the biceps tendon. This condition usually occurs in older individuals and is caused by degenerative changes within the biceps tendon leading to failure of the structure. Many patients have preceding shoulder pain consistent with impingement syndrome or a rotator cuff tear. The proximal biceps tendon rupture may then occur during a simple activity, and occasionally patients may experience some pain relief once the damaged tendon ruptures.

The proximal biceps tendon can rupture in a younger patient with activities such as weight-lifting or throwing sports, but this is quite unusual.  In younger patients, tears of the biceps tendon typically occur where the long head of the biceps attaches to the labrum.

  These injuries are called 'SLAP tears,' a name that describes the location of the tear at the junction of the tendon and the labrum of the shoulder.

Symptoms of a Proximal Biceps Rupture

Typically patients will have sudden pain associated with an audible snap in the area of their shoulder. The pain is usually not significant, and, as mentioned previously, some patients may experience pain relief after the rupture.

After the ruptured tendon retracts, patients may notice a bulge in their arm at the biceps muscle. This is the retracted muscle bunched up in the arm, and is sometime referred to as a "Popeye Muscle," because the muscle is more pronounced than normal.  Other common symptoms of a proximal biceps tendon rupture include:

  • Shoulder swelling
  • Bruising around the biceps muscle
  • Weakness with lifting

Treatment of a Proximal Biceps Rupture

Patients usually do not notice any loss of arm or shoulder function following an isolated proximal biceps tendon rupture. A slight bulge in the arm, and some spasm or cramping of the retracted muscle are usually the most significant symptoms.

The reason there is little functional loss following a proximal biceps tendon rupture is that there are actually two two attachments of the biceps at the shoulder joint (that is why the muscle is named "bi-ceps," meaning two heads). When the rupture occurs at the distal biceps tendon at the elbow, where there is only one attachment, surgical repair is much more commonly needed.

There can be more significant symptoms that impair shoulder function when the biceps rupture occurs in conjunction with other tendon injury of the shoulder, specifically a rotator cuff tear.  If surgery is considered for a ruptured biceps tendon, the typical surgical procedure performed is called a biceps tenodesis.  During this surgical procedure, the biceps tendon is reattached to the bone, but just outside of the shoulder joint.


Nho SJ, et al. "Long Head of the Biceps Tendinopathy: Diagnosis and Management" J Am Acad Orthop Surg November 2010 vol. 18 no. 11 645-656.

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