Biceps tendinopathy and biceps tendon rupture

Last updated: October 25, 2023

Summarytoggle arrow icon

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.

Classificationtoggle arrow icon


Etiologytoggle arrow icon

Pathophysiologytoggle arrow icon

As mentioned in etiology, distal biceps tears are primarily traumatic whereas underlying degenerative disease (e.g., biceps tendinopathy) can lead to proximal tears.

Clinical featurestoggle arrow icon

Biceps tendinopathy

Proximal biceps tendon rupture [1]

  • 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

Distal biceps tendon rupture

Hook test

  • 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

Diagnosticstoggle arrow icon

Diagnosis is primarily clinical. Imaging modalities are used to confirm the diagnosis and determine the extent and location of the rupture.

Treatmenttoggle arrow icon

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.


Referencestoggle arrow icon

  1. Churgay CA. Diagnosis and treatment of biceps tendinitis and tendinosis.. Am Fam Physician. 2009; 80 (5): p.470-6.
  2. Esenkaya I, Unay K. Tendon, tendon healing, hyperlipidemia and statins. Muscles Ligaments Tendons J. 2011; 1 (4): p.169-171.
  3. Virk MS, Cole BJ. Proximal biceps tendon and rotator cuff tears. Clin Sports Med. 2016.doi: 10.1016/j.csm.2015.08.010 . | Open in Read by QxMD
  4. Biceps Tendon Tear at the Shoulder. Updated: December 1, 2013. Accessed: February 23, 2017.
  5. Biceps Tendon Tear at the Elbow. Updated: February 1, 2016. Accessed: February 23, 2017.

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 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer