The bicep is a large muscle on the front of the upper arm, between the elbow and the shoulder. Tendons attach the bicep to the bones in the arm and help it function. A bicep tear refers to damage to one of these tendons, which can cause pain and affect arm mobility.

Three tendons attach the bicep to bone, including two tendons in the shoulder and one that attaches at the elbow to a bone in the forearm. These tendons help keep the bicep in place and allow the arm to flex.

Tendon injuries may happen after an accident or slowly over time, causing varying symptoms ranging from pain and swelling to difficulty using the arm. Treatment and recovery time will vary based on the severity of the bicep tear. In some cases, nonsurgical options may be effective, but some people may require surgery to regain full function of the arm.

This article will discuss bicep tears, including the causes, symptoms, and treatment options.

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The bicep is the large muscle on the front of the upper arm between the elbow and shoulder. It plays an important role in the movement of the arms. Tendons at either end of the bicep connect it to the shoulder and forearm. Tendons are tough, fibrous strands of tissue that connect muscles to bones and help keep muscles stable and facilitate movement.

There are two tendons on the upper part of the bicep that attach to the shoulder. The short head tendon attaches to a bump in front of the scapula — or shoulder blade — called the coracoid process. The long head tendon attaches to the glenoid, the top of the shoulder socket.

A tendon on the lower part of the bicep, called the distal bicep tendon, attaches to part of the radius bone in the forearm called the radial tuberosity. This is a small bump on the bone near the elbow joint.

A bicep tear occurs when one of these tendons becomes either partially or completely severed. This refers to damage that can cause the tendon to detach from the bone completely. In many cases, the tendon may begin fraying. As the damage progresses, the tendon can completely tear. The result is typically a partial or complete loss of function in that part of the arm, as well as additional symptoms such as pain and swelling.

Not only can bicep tears occur at the elbow or shoulder, but they can also be either partial or complete. A complete tear will sever the tendon into two places, which takes a longer time to heal. This type of bicep tear may also require surgery to reattach the tendon and regain strength and function of the arm. Partial tears damage part of the tendon but do not completely sever it.

Partial tears may also lead to complete tears if the tendon begins to fray with continued use. For example, lifting a heavy object or performing a repetitive motion with a partial tear may cause the torn tendon to fray and cause a complete tear.

A bicep tear typically occurs due to either injury or overuse. Injury may cause a tear following any heavy lifting, direct injuries to the arm, or improper use or twisting of the arm. Overuse may result in a tear if the tendons wear down or fray over time. Eventually, the tendons may tear or sever completely without sufficient rest.

Evidence suggests that tears in the upper, or proximal, tendons are more common and are more likely to occur with increasing age. A 2021 article adds that over 95% of distal bicep tendon injuries occur in males, with injuries more common in those between the ages of 35–54.

In addition, performing heavy overhead activities, such as weightlifting or certain physical jobs, and overuse through sports, such as swimming or tennis, can cause wear and tear on the tendons and increase the risk of a bicep tear at the shoulder.

Evidence also indicates that smoking and corticosteroid medications can increase the likelihood of a bicep tear at both the shoulder and the elbow.

The symptoms of a bicep tear can vary based on the location and severity of the tear. Symptoms may include:

  • sudden severe pain in the arm
  • swelling and inflammation
  • warmth in the area
  • bruising around the tear
  • a popping or snapping sound as the injury occurs
  • difficulty using parts of the arm, such as difficulty turning the palm over
  • general weakness in the arm
  • changes in the look of the arm, such as a gap created where the bicep is no longer in position, or the appearance of “Popeye muscle,” a bulge in the arm above the elbow

Diagnosing the type and severity of bicep tear is important to find the correct treatment. Diagnosis typically begins with a physical examination, where doctors will look for signs of injury and loss of function in the arm. Generally, they will be able to observe a complete tear due to changes in the appearance of the arm. However, partial tears are less obvious.

Healthcare professionals can also use imaging tests to help see the extent of the damage to the arm. X-ray images cannot show soft tissue, such as the tendon, but they can help rule out other conditions that may cause pain. To see the tendon itself, doctors may order an ultrasound or MRI scan. These can help them get a complete image of the tendon and surrounding tissues to identify the tear and extent of the damage.

Possible treatment options for a bicep tear may include the below.

Nonsurgical options

Nonsurgical treatments focus on relieving pain and maintaining arm function. Depending on the severity of the injury, they may be a suitable option. However, while many bicep tears can heal over time without surgery, a person may experience a loss of strength in the arm. Nonsurgical options can include:

  • Rest: Avoiding strenuous activities may allow the tendon time to heal. A doctor may suggest using a sling and trying to switch to the other arm to perform basic tasks.
  • Ice: Applying ice packs to the area for 20 minutes at a time may help reduce swelling. However, do not apply these directly to the skin.
  • Medications: Some medications, such as nonsteroidal anti-inflammatory drugs, may help reduce pain and inflammation.
  • Physical therapy: Some rehabilitation exercises may help strengthen muscles and restore the range of motion in the arm.

Surgical options

If the bicep tear is severe or nonsurgical options are not effective, a person may require surgery. In some cases, such as a tear near the elbow, a doctor may suggest surgery as a first option.

The goal of surgery is to reattach the tendon to the bone. While surgical complications are unlikely, they are still possible. A 2016 review notes that delaying surgery has links with a higher risk of complications, which is why doctors may recommend surgery as a first-line treatment in many cases. After the procedure, a person may wear a sling, cast, or splint. A doctor may also suggest therapeutic exercises as the arm begins to heal.

With successful treatment, the overall prognosis of a bicep tear is generally good, although recovery may take time, which may vary greatly. Depending on the severity of the injury and the treatment a person receives, it can take roughly 4–6 months for a partial tear and 6–9 months for a complete tear to heal properly.

Following successful treatment, it is important to follow a doctor’s treatment plan and try not to repeat the cause of injury. Physical therapy and light work activities are vital in restoring function and helping individuals return to their normal activities.

Preventing bicep tears involves being aware of any repetitive motions and trying not to put too much stress on the biceps when working or exercising. It may also be advisable to warm up before using the arms and performing exercises with appropriate form to avoid excessive stress on the tendons.

A person can also consider talking to a doctor or physical therapist about any concerns with movements. They may have tips or exercises to help reduce wear on the tendon or recommend choosing other activities that may cause less wear and tear.

Bicep tears refer to damage to the tendons that support the bicep muscle. They typically occur due to injury or overuse of the bicep, resulting in pain, swelling, and reduced strength and mobility.

In some cases, resting the arm and avoiding activity may be enough for recovery. However, some people may need surgery to reattach the tendon to regain full function of their arm. In both cases, a person must follow a doctor’s treatment plan, typically involving strength and flexibility exercises.