Proximal Biceps Tendon Tear: Diagnosis, Treatment, and Recovery

Understanding Proximal Biceps Tendon Tears

The biceps muscle has two tendons that attach it to the bones of the shoulder, known as the proximal biceps tendons. A tear in these tendons can occur either at the long head of the biceps (most common) or the short head, though the latter is rare. Tears can be partial or complete and often result from repetitive overhead activities, sudden injury, or degenerative changes.

Causes and Risk Factors

  • Overuse and Repetitive Stress: Common in athletes, especially those involved in throwing or overhead sports.
  • Acute Injury: A fall on an outstretched arm or lifting a heavy object improperly.
  • Aging and Degeneration: Wear and tear over time increase the likelihood of a tear.

Symptoms and Diagnosis

Symptoms may include:

  • Sudden, sharp pain in the upper arm.
  • Audible snap or pop at the time of injury.
  • Bruising, swelling, and weakness in the shoulder and elbow.
  • A noticeable bulge in the arm ("Popeye" muscle) if the tendon completely tears and retracts.

Diagnosis typically involves a physical exam and imaging tests such as MRI to confirm the extent of the tear and plan treatment.

Conservative Treatments

Many proximal biceps tendon tears, especially partial tears, can be effectively managed without surgery. Treatment options include:

  • Rest and ice to reduce swelling and pain.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief.
  • Physical therapy to strengthen the surrounding muscles and maintain shoulder function.

Surgical Options

Expanding the discussion on surgical options for proximal biceps tendon tears, particularly focusing on the differences and considerations between open and arthroscopic biceps tenodesis, provides a deeper understanding of these procedures. Both aim to reattach the torn biceps tendon but differ in their approach and specific patient benefits.

Surgical Options for Proximal Biceps Tendon Tear: Open vs. Arthroscopic Biceps Tenodesis

When conservative treatments for a proximal biceps tendon tear do not yield satisfactory results, or in the case of complete tears where surgical intervention is considered the best option, biceps tenodesis emerges as a primary surgical solution. This procedure can be performed using either an open or arthroscopic technique, each with its distinct advantages and considerations.

Open Biceps Tenodesis

Procedure Details:

  • Involves a larger incision over the upper arm, allowing direct access to the biceps tendon.
  • The tendon is then fixed to the humerus bone using screws, anchors, or other fixation devices.


  • Provides the surgeon with a broad view of the tendon and surrounding structures, which can be beneficial in complex cases or when additional shoulder issues need to be addressed.
  • May be preferred for patients with extensive damage to the tendon or where the optimal positioning of the tendon is critical.


  • The larger incision may lead to a longer recovery period and more significant postoperative pain compared to arthroscopic techniques.
  • There is a potential for more noticeable scarring.

Arthroscopic Biceps Tenodesis

Procedure Details:

  • Utilizes small incisions through which a camera and instruments are inserted to perform the surgery.
  • The tendon is fixed to the bone using specialized techniques that may involve anchors or screws, similar to the open method but performed through a much smaller operative field.


  • Minimally invasive, resulting in potentially shorter recovery times and less postoperative discomfort.
  • Reduced scarring and cosmetic benefits due to smaller incisions.
  • Allows for the examination and treatment of other intra-articular shoulder conditions during the same procedure.


  • Requires a high degree of technical skill and experience with arthroscopic procedures.
  • May not be suitable for all types of tendon tears, particularly those with significant tendon retraction or in cases requiring more extensive debridement.

Literature and Outcomes

Studies comparing open and arthroscopic biceps tenodesis show both methods are effective in relieving pain and restoring function. For instance, a review in the Journal of Shoulder and Elbow Surgery indicates no significant difference in outcome or strength between open and arthroscopic tenodesis. However, patient preference and the surgeon's expertise play crucial roles in deciding the most appropriate approach.

Rehabilitation and Recovery

  • Post-Surgery Rehabilitation: Begins with rest and limited movement, gradually introducing exercises to restore range of motion and strength.
  • Outcome: Most patients experience significant improvement in pain and function, with many returning to their previous levels of activity.

Regenerative Therapies

Emerging treatments like PRP injections and stem cell therapy are being explored as options to enhance tendon healing. While promising, these approaches are still under investigation for proximal biceps tendon tears.

From Dr. Dini's Desk: Navigating Your Path to Recovery

From Dr. Dini's Desk: Tailoring Treatment to Each Patient

Choosing between open and arthroscopic biceps tenodesis is a decision that I approach with careful consideration of each patient's specific situation, preferences, and overall health. My extensive experience in both techniques allows me to tailor the surgical approach to achieve the best possible outcomes, taking into account the severity of the tear, the presence of any other shoulder conditions, and the patient's expectations for recovery and return to activity.

I am proud to contribute to this field as a published author, specifically addressing complex disorders of the proximal biceps tendon.

I believe in thorough discussion and education about the available surgical options, ensuring that my patients are fully informed and comfortable with their treatment plan. The ultimate goal is not only to repair the torn tendon but also to address any additional shoulder issues, minimize pain, and expedite recovery, allowing for a return to normal activities and an active lifestyle as swiftly and safely as possible.

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