Sorry to hear that you are struggling with such a rough injury. Often it is stressful knowing what to do as it is a rare injury (Launonen 2020). We are here to help guide you through the options of what to do initially after the injury and what best steps to take during your recovery. The good news is whichever type of biceps injury you have below you will likely make a great recovery. With a physiotherapist who works primarily in elbow and shoulder treatments and a great surgeon (only if required) recovery rarely has many long term issues.

What is it? Where does it rupture?

Biceps brachii rupture: can occur at either the upper tendon of the long head or lower tendon

A biceps rupture is a complete tear of the tendon of the biceps brachii muscle in your upper arm. This can occur in either:

1. the higher tendon (attached to your shoulder socket), or
2. the lower tendon (attached to your forearm bone)

“Popeye” Sign: biceps contracts downwards after upper/proximal tendon tear

How Is It Injured? 

Biceps ruptures usually occur during high-force, sudden contractions of the biceps at the elbow or shoulder. The “Popeye” sign or “Reverse Popeye” sign is the key indicator, as the biceps muscle belly contracts away from the torn tendon.

It is seen in sports/activities such as:

• Weightlifting
• Contact sports e.g. rugby league
• Manual jobs involving repetitive, heavy overhead work.

Although it often occurs suddenly from a single movement, Bicep ruptures are usually seen in individuals (aged 40-60 years) with pre-existing wear and tear in the tendon from repetitive use. Some people have extra risk factors such as elevated body mass index or are smokers (Launonen 2020)

What Imaging Do I Need If Any? 

Diagnosis of Bicep ruptures can be made clinically by your doctor or physiotherapist. 

Imaging in the form of MRI’s can be used to decide between complete or partial tears, or to investigate if any other structures were also injured.

Do I need surgery?

The answer depends on which tendon was injured:

• For upper/proximal Bicep ruptures, a conservative approach without surgery is often chosen, as many people will still have function of the biceps due to its second attachment at the shoulder (short head). If there is ongoing pain and weakness, or if your shoulder needs to withstand repetitive, heavy activities, then surgery might be better for you. This is likely to be a Biceps Tenodesis surgery, where the torn upper biceps tendon is attached into your upper arm bone.
• For lower/distal Bicep ruptures, surgery is required to regain normal function of your elbow. This would likely be a Distal Bicep tendon repair, where the lower tendon is reattached into your forearm bone.
  If you have a partial tear, then conservative management may be suited if you are older, sedentary or have low demands of your elbow.

What Are The Rehab Options?

Bicep Strengthening

Physiotherapy is strongly recommended in the post-operative rehab for both types of surgeries. The management would involve:

1. Initial protection of the repair
2. Gradual restoration of range of movement of the elbow/shoulder
3. Building strength
4. Graded return back to activity and sports.

If managed conservatively, Physiotherapy will aim to minimise pain, improve range of movement and build strength in the biceps and whole upper limb to return you back to activity.

How Long Does It Take To Recover?

Manual workers require a lengthier rehabilitation

Recovery post-surgery will often take 4-6 months before returning to normal, everyday function. For those patients involved in heavy manual tasks or high-load/contact sports, this could be longer (>6 months) due to the high amount of strength required from the biceps.

Those undergoing conservative management return to normal, everyday function in approximately 3 months.

Suffered a biceps tear and unsure what to do?

If you’ve suffered a biceps tear or rupture don’t hesitate to get in contact with us! We can help you get a good start to your rehabilitation journey and return you back to doing what you love!

If you are looking for top quality assessment and treatment of your elbow injury then click the ‘book now’ button for Kevin or Luke. They both will be able to help you decide what path to take and provide you the high quality assessment and treatment that you need.