Biceps tendinopathy is a degenerative condition most commonly affecting the proximal long head of the biceps tendon near its origin from the glenoid. Early identification and effective treatment of biceps tendinopathy can prevent a proximal biceps rupture from occurring. Biceps tendon ruptures are injuries to the biceps muscle that result in the complete or partial severing of the tendon from the bone. The tendon of the long head is most commonly affected, usually as a result of trivial trauma in patients with a pre-existing, degenerative joint condition, (e.g., biceps tendinopathy). The rupture is rarely painful and usually does not cause any significant loss of function. By contrast, a tear involving the insertion of the biceps is most often the result of trauma due to overloading, is acutely painful, and entails a loss of movement in the elbow joint. Ultrasound and MRI are used to confirm the diagnosis. Tendinopathy or rupture involving the long head may be managed conservatively with rest and analgesics, while biceps insertion rupture requires immediate surgical repair to restore functionality.
- Based on location of the rupture
Based on extent of the rupture
- Partial rupture
- Complete rupture
- Biceps tendinopathy 
Proximal biceps tendon rupture 
- Commonly a result of minimal trauma; in the presence of an underlying degenerative disease of the shoulder joint (for more information, see “”)
- Predisposing conditions
- Distal biceps tendon rupture 
Biceps tendinopathy 
- Tendonitis; (inflammation) or tendinosis; (degeneration) of the proximal long head of the biceps tendon at its origin from the glenoid
- Tendonitis → chronic tenosynovitis → degenerative tendinosis → biceps tendon rupture
- Chronic microtrauma increases with age → ↑ insidious inflammation → fraying of the tendon
- Point tenderness at the bicipital groove when the arm is 10° internally rotated
- Clinical tests: Yergason test and Speed test (See “”)
Mostly painless; some tenderness may be present in the intertubercular sulcus
- Usually, no significant loss of function
- Popeye sign: Distal displacement of the biceps belly upon contraction
- Acute, stabbing pain
- Hematoma in the medial region of the cubital fossa
- Limitation of flexion and partial or complete limitation of supination at the elbow joint
- Swelling in the upper arm region created by the recoiled, shortened biceps muscle
- Proximal displacement of the biceps belly upon contraction
- Procedure: The patient is asked to actively flex the elbow at 90° and fully supinate the forearm → the index finger is then placed under the lateral edge of the biceps tendon in the cubital fossa → an attempt is then made to “hook” the tendon (pull it upwards) with the index finger
- Interpretation: With an intact or partially intact biceps tendon, the finger can be inserted 1 cm beneath the tendon, and the subsequent upward movement will be hindered by resistance from the tendon; loss of continuity of the tendon would allow the hooked finger to slip upwards without resistance, and thus suggest a complete tear.
Biceps squeeze test
- Biceps tendinopathy 
- Proximal biceps tendon rupture
- Distal biceps tendon rupture: Surgical repair is necessary to regain full arm strength and function.
Surgical repair should be carried out within 2–3 weeks of rupture. After this period, fibrosis leads to muscle shortening, making it impossible to approximate and attach the separated ends.