The biceps muscle, located on the front of the upper arm, assists with bending the elbow and powerfully twisting the forearm upward. This muscle connects to the skeletal structure through tendons at both ends: two tendons attach the biceps near the shoulder (proximal end), and one tendon connects to the forearm bone near the elbow (distal end). A tear can occur at either the proximal or distal attachment point, though the proximal tear is far more common. Treatment required to repair a torn biceps depends upon the tear’s location and its severity.
Identifying the Injury and Severity
A torn biceps tendon often begins with a sudden, sharp pain in the upper arm or elbow, accompanied by an audible “pop” or snapping sensation. Following the initial trauma, a person may notice bruising that travels down the arm toward the elbow, along with weakness when attempting to bend the elbow or rotate the forearm. A complete tear of the long head of the biceps tendon at the shoulder can lead to a visible deformity.
This deformity, often called the “Popeye muscle,” occurs when the severed tendon allows the muscle belly to recoil and bunch up closer to the elbow. Tears are classified by location and completeness: partial (damaged but not completely severed) or complete (fully detached from the bone). The majority of proximal tears involve only one of the two shoulder tendons, which is why a person can often still use their arm despite the tear. Conversely, a complete tear of the single tendon at the elbow is far less common, but results in a more significant loss of strength if not surgically repaired.
Conservative Treatment Pathways
Non-operative management is a common approach, especially for most proximal biceps tendon tears and for partial tears at either location. The focus of this pathway is not on reattaching the tendon, but on managing symptoms and restoring functional capacity through the remaining intact tendons and surrounding muscles. For many individuals, particularly those who are older or have low physical demands, pain relief and adequate function can be achieved without surgery.
Initial treatment involves the Rest, Ice, Compression, and Elevation (RICE) protocol to reduce immediate pain and swelling. Applying cold packs for 20 minutes several times a day helps manage inflammation in the acute stage. Nonsteroidal anti-inflammatory drugs (NSAIDs) may also be used to decrease pain and control inflammation. While some loss of supination strength may remain after a proximal tear, this is often not significant enough to affect most daily activities.
When Surgery is Necessary
Surgical repair is reserved for complete tears of the distal biceps tendon at the elbow, or for active individuals, such as athletes or manual laborers, with a proximal tear who require maximum strength restoration. Complete distal tears require surgery because non-operative treatment can result in a significant loss of arm strength, potentially up to 30% loss in flexion and 40% loss in forearm supination. The goal of the surgery is to re-establish the connection by reattaching the torn tendon to the bone.
For a distal biceps tear, the surgical procedure involves reinserting the tendon onto the radial tuberosity, a small bump on the radius bone in the forearm. Surgeons use specialized techniques, often involving suture anchors or bone tunnels, to securely fix the tendon back to the bone. If surgery is chosen for a proximal tear, the procedure is called a biceps tenodesis, which involves reattaching the torn tendon to a different location on the humerus bone. This tenodesis procedure helps alleviate pain, addresses the cosmetic “Popeye” deformity, and restores strength, though it is a longer operation with a more restricted recovery period compared to non-operative treatment.
The Rehabilitation and Recovery Timeline
Regardless of whether the tear is treated conservatively or surgically, a structured physical therapy (PT) program is necessary for a full recovery. Following a surgical repair, the arm is immobilized in a sling or brace for the first few weeks to protect the reattached tendon. The initial phase of rehabilitation focuses on gentle, passive range of motion exercises to prevent stiffness in the elbow and shoulder without stressing the repair site.
Light activity and active range of motion often begin around four to six weeks post-surgery, with strengthening exercises gradually introduced after two to three months. The progression is managed to allow the tendon to heal completely before heavy loading is permitted. Full recovery and a return to high-demand activities or sports usually take between four to six months following a successful surgical repair. For those managed conservatively, symptoms improve over several weeks to a few months, and PT focuses on regaining full range of motion and strengthening the muscles that compensate for the injured tendon.