Biceps Tendon Rupture (Long Head)

Rupture of the long head of the biceps tendon is a complete tear at or near the proximal attachment point at the supraglenoid tubercle. The tendon retracts distally, producing the characteristic "Popeye" bulge. It most commonly occurs in men over 40 with underlying tendon degeneration.

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Typical Recovery Time

Non-surgical: 6–8 weeks; tenodesis: 4–6 months

Symptoms

•Sudden audible pop at the front of the shoulder
•Immediate pain that often subsides quickly
•Visible Popeye deformity in the mid-upper arm
•Bruising tracking down the arm
•Mild weakness with supination

Common Causes

•Chronic biceps tendinopathy leading to rupture
•Sudden eccentric loading or heavy lift
•Associated rotator cuff tear weakening the shoulder complex
•Corticosteroid injections over time
•Age over 40 as primary risk factor

Treatment Options

1Non-surgical management for older or low-demand patients (most tolerate well)

2Biceps tenodesis for active patients wanting full strength restoration

3Rehabilitation focusing on supination and elbow flexion strength

4Return-to-sport protocol for athletes

When to See a Doctor

See a provider for confirmation of diagnosis and to discuss whether surgery is indicated based on your activity level and cosmetic concerns.

Frequently Asked Questions

What is a long head biceps tendon rupture?

A long head biceps tendon rupture is a tear of the biceps tendon near the shoulder. This tendon runs through the front of the shoulder and helps with arm movement. When it tears, some people notice a bulge in the upper arm called a Popeye deformity.

What causes a long head biceps tendon rupture?

It can happen suddenly during lifting or from a forceful arm movement. It can also occur gradually when the tendon is weakened by inflammation or wear. Rotator cuff problems are commonly associated with this injury.

What are the symptoms?

Symptoms may include a sudden pop, pain in the front of the shoulder, bruising, and weakness. Some people notice the biceps muscle looks lower or more prominent. Pain often improves after the tendon fully tears, but weakness or cramping can remain.

Do I need surgery for a biceps tendon rupture?

Many long head biceps tendon ruptures are treated without surgery, especially if shoulder function is acceptable. Physical therapy can help restore strength and motion. Surgery may be considered for younger, highly active patients or those with persistent cramping or cosmetic concerns.

How long does recovery take?

Recovery usually takes several weeks to a few months depending on pain, strength, and activity goals. Most people can return to daily activity relatively quickly. Return to sports or heavy lifting should wait until strength and comfort have improved.

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