A biceps tendon tear occurs when the tendon completely or partially severs from the bone. When the tear occurs at the shoulder, a person may experience pain and lose some strength in their arm.

Also known as a proximal biceps tendon tear, it often triggers a sudden burst of sharp pain from a single traumatic event. However, a person can often still use their arm successfully.

Sometimes, tendon tears at the shoulder barely cause noticeable symptoms. Treatment aims to relieve symptoms, and surgery is usually unnecessary unless symptoms do not improve.

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Tendons connect bones to muscles, providing strength and stability. The biceps tendons fulfill this role in the shoulder and elbow. Injuring or overusing the joint can lead to a tear at the shoulder end of the tendon.

The biceps muscle has two different heads that connect to the shoulder blade. These tendons help keep the ball-shaped connection at the top of the arm centered in the socket of the shoulder joint. These can tear following trauma or overuse.

The tendon often starts tearing by gradually fraying or wearing down over time. These are usually partial tears but can sometimes be complete, splitting the tendon in two.

A biceps tendon tear can occur at the shoulder or elbow. However, tears at the shoulder are more common than those at the elbow. A tear at the elbow is also known as a distal biceps tendon tear. Most distal biceps tendon tears are complete, meaning the tendon completely severs from the bone.

Biceps tendon tears at the shoulder may occur due to injury and overuse. Various factors also increase a person’s risk of this type of tendon injury.

No specific type of arm injury or movement causes biceps tendon tears at the shoulder. However, a heavy fall on an outstretched arm or lifting a heavy object can tear the biceps tendon.

Over time, the joint can wear down. This is a natural result of aging but can also occur due to repeating the same shoulder motion for a long time.

This gradual fraying can lead to several shoulder issues, including:

These shoulder issues increase how hard the biceps tendons have to work. This makes a tear more likely.

Risk factors

The following groups of people may have weaker or more worn soft tissue and an increased risk of a biceps tendon tear at the shoulder:

  • older adults
  • people who smoke
  • individuals who have obesity
  • people who regularly use corticosteroids
  • individuals who lift excessively heavy weights over their heads, such as weightlifters or those with jobs that require such a motion
  • people who are more likely to regularly move their arms in an overhead motion, such as those who regularly swim or play tennis

Other less common risk factors include:

Not every person with this type of tendon tear experiences symptoms. However, those who do may notice the following:

  • a popping sound
  • sudden, severe pain in the upper arm
  • cramps in the biceps when using the arm for intense activity
  • bruises from the middle of the arm to the elbow
  • shoulder and elbow tenderness or pain
  • finding it difficult to turn the palm to face upward or downward
  • a bulge in the upper arm above the elbow, sometimes known as “Popeye muscle”

A physician will ask about medical history and any recent injuries that may relate to the biceps tear. They will then examine the biceps.

Complete tears are more obvious due to Popeye muscle. This term refers to a tightening of the muscle, making the biceps appear closer to the elbow.

Partial tears are less easy to diagnose. The doctor may ask an individual to bend the arm and flex their biceps. If this is painful, it may be due to a partial tear. They will request further tests to assess the arm and shoulder for further damage.

For example, the doctor may request an X-ray even though this would not show damage to soft tissue. Doctors will also request an MRI scan to create a clearer image of the biceps tendon tear and guide treatment.

In many cases, pain from a biceps tendon tear at the shoulder will resolve over time. Symptoms such as mild arm weakness may not be too bothersome for many people. As such, if there is no damage to structures in the shoulder, such as the rotator cuff, a doctor may suggest nonsurgical options.

Nonsurgical options

These may include:

  • applying an ice pack to the area for 20 minutes at a time, several times a day, to reduce swelling
  • taking nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, or naproxen
  • resting from physical activities, especially those that require heavy lifting or overhead work
  • practicing physical therapy exercises, including those that work on flexibility and strength in the shoulder

Even people who need or choose surgery will benefit most from ongoing physical therapy. This will slowly help people to restore strength and resume their usual activity levels.

Surgical options

In other cases, a person may elect for surgery. This may be a reasonable option for individuals who require a quicker recovery and return to activity, such as athletes or manual laborers. It may also be an option for individuals who continue to experience symptoms after nonsurgical treatment.

Different surgical approaches are available. A biceps tenodesis aims to reattach the torn tendon to the shoulder. A biceps tenotomy involves splitting or removing part of the tendon.

For most individuals who follow recovery guidelines, a full recovery may be possible within 8 to 12 weeks.

People who choose surgery can resume lighter activity shortly after surgery. However, they should also avoid heavy lifting for several months.

During this time, a physical therapist may slowly add light resistance training to the rehabilitation program. This might include gently flexing the biceps or using elastic resistance bands. These can support recovery for both strength and full range of motion.

A biceps tendon tear at the shoulder occurs when the biceps tendon that connects to the shoulder partially or completely tears. Sometimes, it may not cause noticeable symptoms. However, for some people it can be visibly noticeable and cause pain and weakness in the arm.

The injury generally recovers without surgery, but some individuals choose to have surgery to return to heavy lifting or intense physical activity.

It often occurs due to heavy overhead lifting or shoulder overuse, especially in sports, activities, or jobs that involve heavy overhead lifting. Full recovery can take around 8 to 12 weeks, and physical therapy can help improve recovery outcomes.