Biceps Tendon Repair Surgery
The biceps muscle is anchored to the skeleton by tendons at both ends — the proximal biceps tendons at the shoulder (the long head and short head) and the distal biceps tendon at the elbow. When one of these tendons tears or ruptures, it can produce sudden pain, visible deformity, and significant loss of arm strength that affects everything from lifting and carrying to rotating the forearm. Proximal biceps tendon tears at the shoulder are more common, typically occurring in patients over 40 as a result of chronic tendon degeneration — often in association with rotator cuff disease, shoulder impingement, or years of repetitive overhead use. Distal biceps tendon ruptures at the elbow are less common but tend to occur more suddenly — typically during a forceful lifting or curling movement — and produce a more dramatic functional deficit because the distal tendon is the primary driver of forearm supination (turning the palm upward) and a major contributor to elbow flexion strength.
Dr. Jonathan Glashow is a board-certified orthopedic surgeon and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, with specialized shoulder training that includes a traveling fellowship under Dr. Charles Rockwood and Dr. Richard Hawkins and fellowship training in arthroscopic surgery at the Southern California Orthopedic Institute/UCLA. This combined shoulder and upper extremity expertise is essential for biceps tendon injuries, which often coexist with rotator cuff tears, labral pathology, and shoulder impingement — conditions that must be evaluated and addressed together for an optimal outcome. As Chief Medical Officer for the New Jersey Devils and Philadelphia 76ers, Dr. Glashow manages acute biceps ruptures in professional athletes where rapid diagnosis and timely surgical repair are critical for career preservation. With more than 15,000 procedures performed and recognition as a Castle Connolly Top Doctor every year since 2000, he performs biceps tendon repair at his Upper East Side practice in New York City.
Causes of Biceps Tendon Tears
There are two main causes of biceps tears and ruptures — injury and overuse.
Injury: A sudden force — such as falling hard on an outstretched arm, attempting to catch a heavy object, or performing an explosive lift — can tear the biceps tendon acutely at either the shoulder or the elbow.
Overuse: Many proximal biceps tears result from gradual wearing and fraying of the tendon over time, aggravated by repetitive overhead motions. Conditions such as shoulder impingement, rotator cuff tendinopathy, and chronic tendinitis place additional stress on the biceps tendon, making it progressively weaker and more susceptible to partial or complete tearing. Age-related degeneration is the most common contributing factor in proximal tears.
A complete biceps rupture involves a full tear of the tendon from its attachment point. Pain is initially intense but may subside after one to two weeks — which can mislead patients into thinking the injury has resolved, even though the tendon remains detached and arm strength is permanently diminished without repair.
Symptoms of a Biceps Tendon Rupture
- Sudden, sharp pain in the shoulder or front of the elbow at the time of injury
- An audible pop or snapping sensation
- Swelling and bruising in the upper arm or front of the elbow
- Weakness in bending the elbow or rotating the forearm
- A visible bulge in the upper arm from the retracted muscle — the “Popeye” deformity
- A gap or hollow in the front of the elbow where the tendon is absent (distal tears)
- Difficulty turning the palm upward, such as when using a screwdriver or turning a doorknob (distal tears)
Diagnosis and Evaluation
Dr. Glashow evaluates suspected biceps tendon injuries with a thorough medical history, physical examination assessing range of motion, strength, and stability of the shoulder and elbow, and diagnostic imaging. X-rays are used to rule out fractures or bone spurs. An MRI provides detailed visualization of the tendon and identifies whether the tear is partial or complete, the degree of tendon retraction, and any associated shoulder pathology — such as rotator cuff tears or labral damage — that may need to be addressed simultaneously. Same-day X-rays and MRI are available at his Upper East Side practice.
Biceps Tendon Repair Surgery in New York City
If you have experienced a sudden pop in your shoulder or elbow, noticed a visible change in the shape of your upper arm, or are experiencing weakness in elbow flexion or forearm rotation, you may have sustained a biceps tendon rupture — and early surgical repair produces the best outcomes. Dr. Glashow offers same-day evaluation with on-site imaging at his Upper East Side practice. Contact our office to schedule your consultation.
Frequently Asked Questions About Biceps Repair Surgery
What is the difference between a proximal and distal biceps tear?
A proximal biceps tear occurs at the shoulder, where the long head of the biceps tendon attaches to the top of the glenoid (shoulder socket) at the labrum. A distal biceps tear occurs at the elbow, where the single distal tendon attaches to the radius bone in the forearm. Proximal tears are more common and often occur gradually from chronic degeneration. Distal tears are less common but tend to occur suddenly from a forceful eccentric contraction — such as catching a heavy object or performing a heavy curl. The treatment approach differs: many proximal tears can be managed non-operatively, while complete distal tears almost always require surgical repair to restore forearm strength.
Do all biceps tears require surgery?
No. Many proximal biceps tendon tears — particularly in older, less active patients — can be managed successfully with conservative treatment including rest, anti-inflammatory medications, and physical therapy. The long head of the proximal biceps is primarily a shoulder stabilizer, and when it tears, the short head can often compensate adequately for most daily activities. However, patients who need full arm strength for work or sport, patients with a cosmetically unacceptable “Popeye” deformity, and patients with associated rotator cuff or labral injuries may benefit from surgical repair. Complete distal biceps ruptures at the elbow are nearly always repaired surgically, because the loss of supination strength and grip strength without repair is substantial and permanent.
How soon after a biceps rupture should surgery be performed?
For distal biceps tendon ruptures, early repair — ideally within the first two to three weeks — produces the best results, because the tendon begins to retract and scar tissue forms in the gap, making delayed repair significantly more difficult. For proximal biceps tears at the shoulder, timing is less urgent — but if surgery is indicated, earlier repair generally allows for easier tendon mobilization and a more straightforward procedure. Dr. Glashow recommends prompt evaluation for any suspected biceps rupture so that the surgical window is not missed.
What does biceps tendon repair surgery involve?
For proximal biceps tears at the shoulder, the most common procedure is a biceps tenodesis — in which the torn tendon is reattached to the humerus (upper arm bone) using a screw, suture anchor, or interference fixation, removing it from the shoulder joint where it was a source of pain. This can be performed arthroscopically or through a small incision. For distal biceps tears at the elbow, the torn tendon is reattached to the radius bone through a small incision in the front of the elbow using suture anchors, a cortical button, or an interference screw. Both procedures are typically performed on an outpatient basis.
How long does recovery take after biceps repair?
Recovery depends on which tendon was repaired. For proximal biceps tenodesis, patients typically wear a sling for two to four weeks with early range-of-motion exercises, returning to daily activities within four to six weeks and full strength by three to four months. For distal biceps repair at the elbow, patients wear a brace and limit lifting for four to six weeks, with progressive strengthening beginning around six to eight weeks and full return to heavy lifting and sports at four to six months. Dr. Glashow coordinates rehabilitation closely with physical therapists and advances each patient based on healing progress rather than a fixed calendar.
Can a biceps tear happen again after repair?
Re-rupture after surgical repair is uncommon — published rates are generally below 5 percent for both proximal and distal repairs when modern fixation techniques are used and the rehabilitation protocol is followed. The most common risk factors for re-rupture are returning to heavy lifting too early before the tendon has fully incorporated into the bone, and poor tendon tissue quality at the time of repair (which can occur in patients with significant pre-existing degeneration). Dr. Glashow uses strong fixation methods and monitors healing progress with clinical examination before advancing the rehabilitation timeline.
