Biceps Tendon Problems
The long head of the biceps tendon runs through the front of the shoulder and can become inflamed, partly tear, or fully rupture — causing front-of-shoulder pain and sometimes a "Popeye" bulge in the arm.
What can go wrong with the biceps tendon?
One of the two biceps tendons (the long head) passes through the shoulder, where it is prone to wear. It can become inflamed (tendinitis), develop a partial tear, or rupture completely — which produces the classic "Popeye" bulge as the muscle settles lower in the arm. Because of where it sits, biceps problems often go hand in hand with rotator cuff or labral issues.
Symptoms to watch for
- Aching pain at the front of the shoulder, worse with lifting or overhead reaching
- Sometimes a snapping or catching sensation in the front of the shoulder
- With a rupture: a sudden pop, bruising, and a visible bulge in the upper arm — often followed by surprisingly little pain
How it is diagnosed
A physical exam locates tenderness over the tendon and tests biceps strength. An MRI or ultrasound can confirm the diagnosis and check the nearby rotator cuff and labrum.
Treatment
Inflammation (tendinitis) is usually treated with rest, anti-inflammatories, therapy, and sometimes an injection. A rupture of the long head at the shoulder is frequently treated without surgery, especially in older patients, because overall arm strength is usually preserved.
When pain persists, or in younger and more active patients, the tendon can be surgically secured (a tenodesis), often at the same time as a rotator cuff repair. A distal biceps rupture — at the elbow rather than the shoulder — is a different injury that more often needs prompt repair.
Front-of-shoulder pain or a new bulge in your arm?
An evaluation can sort out what's involved and what to do.
Common questions
It looks dramatic but is usually not harmful. A long-head biceps rupture at the shoulder typically leaves arm strength largely intact.
Often not, for the shoulder (long head). Surgery is considered mainly for persistent pain, cosmetic concerns, or in younger, active patients.
Most people notice little functional loss after a long-head rupture at the shoulder. A distal biceps rupture at the elbow is different and more likely to affect strength.
The shoulder (long head) tear is usually managed without surgery; the distal (elbow) tear more often needs timely repair to preserve strength.
This page is for general education and is not a substitute for an in-person evaluation. Your specific diagnosis and treatment plan should come from Dr. Hachadorian based on your exam and imaging.