Physical Therapy Guide to Biceps Tendon Rupture
A biceps tendon rupture occurs when the tendon attaching the biceps muscle to the shoulder or elbow is torn. This can create pain near the shoulder or elbow, weakness, bruising, and visible deformity in the upper arm. Most commonly, the biceps tendon tears at the shoulder. The injury occurs in men more than women. When it occurs in younger people, it usually results from trauma or sudden injury (such as an auto accident, fall, contact sport incident, or lifting/moving a heavy object). The injury also can occur from overuse. Biceps tendon ruptures occur at any age but are more common in people ages 40 to 60. People who do repeated overhead or heavy lifting, and athletes who lift weights or play aggressive contact sports are at increased risk.
Physical therapists help people regain flexibility, strength, and function in their arms following biceps tendon ruptures. People who find it difficult to perform their daily activities, including reaching, lifting, or carrying, as well as athletes and those with high-level work demands, benefit greatly from physical therapy following injury.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
What Is a Biceps Tendon Rupture?
The biceps is a muscle that involves the shoulder and the elbow. A tendon is a fibrous bundle that at the end of muscles where they attach to bone.
The shoulder is a complex ball-and-socket joint made up of three bones:
- Upper-arm bone (humerus).
- Shoulder blade (scapula).
- Collar bone (clavicle).
“Bi” means two. The biceps muscle has two “heads” (the long head and the short head). These heads merge and span the length of the upper arm from the shoulder area to the elbow joint.
The biceps tendons attach the biceps muscle to bone in three places:
- The tendon of the long head attaches to the upper arm bone near the shoulder socket.
- The tendon of the short head attaches to a bony bump on the shoulder blade near the collar bone.
- The tendon near the elbow attaches to a lower arm bone (radius) just below the elbow joint.
The biceps muscle is responsible for:
- Bending (flexing) the elbow.
- Rotating the forearm.
- Providing minor support to lifting the arm at the shoulder.
Biceps tendon rupture near the shoulder. It is most common for the biceps tendon to tear at the long head of the biceps muscle at the upper-arm bone, leaving the short head attachment intact.
A person with this type of rupture can still use their arm but will have weakness in the shoulder and upper arm.
A tear can be:
- Partial: Part of the tendon remains intact and only a portion is torn away from the bone.
- Complete: The entire tendon is torn away from the bone. Surgery is not required for all biceps tendon ruptures. It may be recommended for very active adults or if your symptoms cannot be relieved with conservative treatments.
Biceps tendon rupture near the elbow. When the biceps tendon tears near the elbow, it is more likely to need surgery to reattach the tendon. Consult with your orthopedist or physical therapist to determine your condition and find out which treatment options are best for you.
How Does It Feel?
After a biceps tendon rupture, you may experience:
- Sharp pain in the upper arm or elbow.
- Hearing or feeling a "pop" or snap at the shoulder or elbow.
- Bruising and swelling in the upper arm to elbow.
- Weakness in the arm when bending the elbow, rotating the forearm, or lifting the arm overhead.
- Tenderness in the shoulder or elbow.
- Muscle spasms in the shoulder and arm.
- A bulge or deformity in the lower part of the upper arm (a “Popeye arm”).
How Is It Diagnosed?
In most cases, your physician or physical therapist can diagnose a biceps tendon rupture with a thorough history and physical exam of the involved arm.
Your physical therapist will ask you several questions regarding your medical history, your daily tasks at home and at work, and your recreational or sports activities. They will ask how the injury happened and where you are feeling pain and/or weakness.
Your physical therapist will then perform a physical exam, which may include:
- Examining your entire upper arm for bruising, swelling, or signs such as bulging at the muscle or a gap where the tendon should be.
- Gently pressing to determine if there is any tenderness over the biceps region at the shoulder, upper arm, or elbow.
- Assessing the amount of motion and strength present on the involved side in the shoulder, forearm, and elbow. Comparing that to the motion and strength of your other arm.
- Testing to see what daily tasks are difficult for you to do. These may include lifting an object, reaching overhead, reaching behind the body, or rotating the forearm to open a door.
How Can a Physical Therapist Help?
Depending on its severity, a biceps tendon rupture at the shoulder often can be treated without surgery. If a rupture occurs near the elbow, surgery is more likely.
If surgery is not required, your physical therapist will design a personalized treatment program to help heal your injury in the safest and most efficient way possible. Treatment may include:
Rest. You will be instructed in ways to allow the limb to rest to promote healing.
Icing. Your physical therapist will show you how to apply ice to the affected area to manage pain and swelling.
Range-of-motion activities. Your physical therapist will teach you gentle mobility exercises for the shoulder, elbow, and forearm, so your arm does not get stiff during the healing process.
Strengthening exercises. As the pain and swelling ease, your physical therapist will teach you gentle strengthening exercises. You may use resistant bands or light weights.
Functional activities. You will learn exercises to help you return to the activities you performed before the injury.
Patient education. Your physical therapist will teach you how to protect your joints from further injury. You will learn how to properly lift objects once the arm is healed, and how to avoid lifting objects that are simply too heavy.
If Surgery Is Required
You are more likely to need surgery for a biceps tendon rupture if:
- Your biceps tendon rupture occurred at the elbow.
- You are an athlete.
- Your job requires you to regularly lift or move heavy objects.
If you have surgery, you will follow a physical therapy program to restore the movement, strength, and flexibility of your affected arm. Your physical therapist will guide you through your post-surgery recovery. They will make adjustments to your treatment plan as needed, based on your condition and goals.
- After surgery, your arm may be kept in a sling or brace to prevent your elbow from straightening all the way. You may have to limit your lifting/carrying for a few weeks.
- Later, you can gradually increase your arm movements and build strength. Your physical therapist will guide you through a program to help you safely regain your ability to perform activities.
- Late-stage exercises may include sport- or work-specific activities to ensure you are ready to return to your prior level of function.
Your physical therapist will work with you to answer any questions. They will guide you in your recovery in the safest, most effective way possible.
Can This Injury or Condition Be Prevented?
Physical therapists offer advice and design exercise programs to help people build strength, improve balance, and avoid injury. To prevent a biceps tendon rupture, you should:
- Maintain proper strength in the shoulder, elbow, and forearm. Your physical therapist can design a strengthening program to fit your needs and goals.
- Avoid repetitive overhead lifting and general overuse of the shoulder, such as forceful pushing or pulling activities, or lifting objects that are simply too heavy. Note: Lifting more than 150 pounds can be dangerous for older adults.
- Use special care when doing activities such as lowering a heavy item to the ground.
- Avoid smoking. It introduces carbon monoxide into the body and leaves less oxygen for the muscles to grow and heal.
- Avoid steroid use. It weakens muscles and tendons.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat conditions such as biceps tendon ruptures. You may want to consider:
- A physical therapist who is experienced in treating people with shoulder and elbow conditions or injuries. Some physical therapists have a practice with an orthopedic or sports focus.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can search for physical therapists in your area who have these and other credentials by using Find a PT, a tool built by the American Physical Therapy Association.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family, friends, or other health care providers.
- Ask about the physical therapist's experience in helping people with biceps tendon rupture when making an appointment.
- Be prepared to describe how your injury occurred and your symptoms in as much detail as possible.
The American Physical Therapy Association believes that consumers should have access to information that can:
- Help them make health care decisions.
- Prepare them for a visit with their health care provider.
The following articles provide some of the best scientific evidence for the treatment of proximal humerus fracture. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to the free full text, so that you can read it or print out a copy to bring with you to your health care provider.
American Academy of Orthopaedic Surgeons. OrthoInfo website. Biceps Tendon Tear at the Elbow.
American Academy of Orthopaedic Surgeons. OrthoInfo website. Biceps Tendon Tear at the Shoulder.
Hsu D, Anand P, Mabrouk A, et al. Biceps tendon rupture. In: StatPearls [Internet]. StatPearls Publishing. Updated September 25, 2022. Article in National Library of Medicine.
Medscape. Surgical intervention.
Srinivasan RC, Pederson WC, Morrey BF. Distal biceps tendon repair and reconstruction. J Hand Surg Am. 2020;45(1):48–56. Article Summary in PubMed.
Giacalone F, Dutto E, Ferrero M, et al. Treatment of distal biceps tendon rupture: why, when, how? Analysis of literature and our experience. Musculoskelet Surg. 2015;99 Suppl 1:67–73. Article Summary in PubMed.
*PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.