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  • Biceps distal tear

  • Biceps proximal tear


  • 727.62 Nontraumatic rupture of the tendons of biceps (long head)

  • 840.8 Sprains and strains of other specified sites of shoulder and upper arm


  • M66.829 Spontaneous rupture of other tendons, unspecified upper arm

  • S46.119A Strain of muscle, fascia and tendon of long head of biceps, unspecified arm, initial encounter


  • 4D: Impaired joint mobility, motor function, muscle performance, and range of motion associated with connective tissue dysfunction

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation1


A 42-year-old man presents with upper arm pain and decreased ability to flex or extend the arm. The patient is a construction worker and tried to catch a falling piece of heavy metal. The patient states he heard a loud pop in the upper arm. Upon observation he has an abnormal biceps appearance with limited strength in elbow flexion. The patient smokes two packs of cigarettes a day.



  • Rupture of the biceps brachii tendon either complete or partial

  • Distal rupture will cause swelling, bruising, and a gap in front of elbow created by absence of tendon

    • Avulsion of the tendon from the radial tuberosity

  • Proximal rupture will cause bulging, bruising, and gathering of the muscle (“Popeye” sign may indicate rupture)

    • Avulsion of the long head of the biceps brachii from the superior rim of the anterior glenoid labrum

FIGURE 152-1

A patient with rupture of the biceps tendon. Note the “Popeye” appearance of the muscle. (From Simon RR, Sherman SC. Emergency Orthopedics. 6th ed. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Essentials of Diagnosis

  • History and clinical examination

  • Diagnosis of proximal tear often easily visible with observation due to bulge left by deformed muscle (“Popeye sign”)

  • Diagnosis of distal tear

    • Palpation of gap at the elbow

    • Manually testing supination strength compared with uninvolved side

    • Sudden event trauma

  • Partial tears harder to diagnose and may require manually testing bicep muscle for signs of pain with activation of muscle

  • Occurs from a sudden high force, typically with weightlifting (i.e., biceps curls or activities with elbow flexion), eccentric force

  • May arise from a repetitive type activity that leads to a gradual degeneration

  • MRI to show both partial and complete tendon tears

General Considerations

  • History of repetitive motion, especially activities overhead

  • Common in swimming, tennis, baseball, and with occupational activities involving repetitive or overhead activity due to microtrauma

  • Smoking affects overall nutrition of tendon due to nicotine side effects

  • Corticosteroid medications ...

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