Author: Mr Oliver Eaton BSc (Hons), PG.Cert – Orthopaedic Specialist
Reviewed by: Mr William Sharples BSc (Hons) – Pain Management Expert
Last Updated: September 2025
In this article, you will learn everything you need to know about bicep tendon tears and the most effective ways to treat it, including an advanced treatment called Prolotherapy.
Introduction
Bicep tendon tears are a common injury, especially among athletes and people who perform repetitive lifting or overhead activities. These tears can occur at the shoulder and elbow, impacting overall arm function, including strength and the ability to perform movements like elbow flexion and forearm supination. A tear can cause pain, weakness, and a noticeable change in the shape of the upper arm. Proximal biceps tendon injuries are often associated with rotator cuff pathology, so it is important to evaluate both conditions during diagnosis and management. Early diagnosis and the right treatment are crucial for optimal recovery and return to function.1
What Is a Bicep Tendon Tear?
The biceps muscle has two tendons at the shoulder (the long head and short head) and one tendon at the elbow. These are known as the proximal biceps tendons at the shoulder and the distal biceps tendon at the elbow. The tendons that attach the biceps muscle to the shoulder and elbow enable important movements such as elbow flexion and forearm supination. The distal biceps tendon attaches to the radial tuberosity on the radius bone at the elbow, playing a crucial role in arm movement and strength. A distal biceps tendon rupture occurs at the elbow, often at the site where the distal tendon attaches to the radial tuberosity, and can significantly affect arm strength. The proximal biceps tendon is commonly involved in shoulder injuries, and proximal tendon rupture typically affects the long head at the shoulder. Tears of the biceps tendons can be partial or complete and may occur at either the shoulder or elbow. Most commonly, the long head of the biceps tendon is affected. Tears can result from sudden injury, heavy lifting, or chronic wear and tear.2
Symptoms of a Bicep Tendon Tear
- Sudden, sharp pain in the upper arm or elbow
- “Popping” or tearing sensation
- Bruising and swelling
- Arm weakness, especially in the shoulder or elbow, is a common symptom
- Difficulty rotating the forearm, with loss of supination strength and reduced forearm supination
- Visible bulge (“Popeye deformity”) in the upper arm, often seen when the tendon is completely torn
- Cramping or muscle spasms
- A biceps rupture can result in a sudden loss of strength and function in the injured arm
Diagnosis
Diagnosis begins with a physical examination, where the doctor assesses the injury by inspecting and evaluating the affected area, along with reviewing the patient’s medical history. The Ruland biceps squeeze test is a specific physical exam maneuver used to assess for biceps tendon rupture. Imaging tests such as ultrasound or magnetic resonance imaging (MRI) are used to confirm the location and extent of the tear. Magnetic resonance imaging (MRI) is particularly useful for visualizing soft tissues and confirming tendon rupture, as it provides superior detail compared to X-rays, especially when assessing muscle and tendon injuries. Early diagnosis is important to prevent long-term weakness or deformity.3
Treatments for Bicep Tendon Tears
Treatment depends on the severity, location, and your activity level. Options include:
- Rest and activity modification: Avoid activities that worsen pain. Nonsurgical treatment, such as rest, anti-inflammatory medication, and physical therapy, is a conservative approach for some cases, especially when relieving pain and restoring function are the main goals.
- Ice and anti-inflammatory medications: Reduce pain and swelling.
- Physical therapy: Restore strength and flexibility. Strengthening exercises are important in rehabilitation after both surgical and nonsurgical treatment to help regain muscle function.
- Bracing or slings: May be used for comfort in the early stages.
- Surgery: Recommended for complete tears in active individuals or when function is significantly impaired. Surgical treatment options include open and arthroscopic surgery, with arthroscopic surgery offering a minimally invasive approach for some biceps tendon repairs. Suture anchors or suture anchor fixation are commonly used to securely reattach the tendon, especially in distal biceps tendon ruptures, where the tendon is fixed to the radial tuberosity. Biceps tenodesis and biceps tenotomy are surgical options, particularly for proximal biceps tendon injuries. Tendon retraction can occur after a complete rupture, making timely surgical intervention important for optimal outcomes.
Distal biceps tendon ruptures, distal biceps ruptures, and distal tendon ruptures are specific injuries at the elbow that may require surgical repair. Tendon ruptures, including ruptured tendon, ruptured biceps tendon, and torn biceps, require prompt evaluation to determine the best treatment approach. Risk factors for biceps tendon tears include age, overuse, and certain medical conditions. Early treatment of tendon ruptures is important to restore function and prevent complications.
Prolotherapy
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat bicep tendon tears. Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits. Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with bicep tendon tears. As prolotherapy is helping to treat the root cause of bicep tendon tears, it is deemed to be a permanent fix, preventing the symptoms from returning.
Disclaimer: The information provided in this section is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Prolotherapy may not be suitable for everyone, and outcomes can vary. Always seek the guidance of a qualified healthcare professional regarding your specific medical condition or treatment options. Never disregard professional medical advice or delay seeking it because of information you have read here.
Recovery and Rehabilitation
Most people recover well with a combination of rest, physical therapy, and, if needed, advanced treatments. Regaining forearm supination strength and overall arm function is a key goal of rehabilitation, as these are essential for performing daily activities and specific movements after injury. Recovery time varies: partial tears may heal in weeks, while complete tears (especially after surgery) may take several months. Strengthening exercises play an important role in restoring muscle function and supporting recovery during this period. Adhering to a rehabilitation program is key to regaining strength and function.4
Case Studies
Case Study 1: Partial Bicep Tendon Tear in a Weightlifter
Background: A 35-year-old weightlifter experienced sudden pain and weakness during a heavy lift.
Treatment: Rest, physical therapy, and prolotherapy.
Outcome: Full recovery and return to lifting within 8 weeks.
Case Study 2: Complete Distal Bicep Tendon Tear in a Manual Worker
Background: A 50-year-old manual worker suffered a complete tear at the elbow.
Treatment: Surgical repair followed by prolotherapy and rehabilitation.
Outcome: 90% strength restored and return to work within 4 months.
Case Study 3: Chronic Shoulder Pain from Bicep Tendon Degeneration
Background: A 60-year-old with chronic shoulder pain and partial bicep tendon tear.
Treatment: Prolotherapy and targeted physiotherapy.
Outcome: Significant pain reduction and improved shoulder function.
Frequently Asked Questions
What causes a bicep tendon tear?
Tears can result from sudden injury (lifting, falling), repetitive overhead activity, or degeneration from aging and overuse.2
How is a bicep tendon tear diagnosed?
Diagnosis is based on physical exam, history, and imaging (ultrasound or MRI) to confirm the tear and guide treatment.3
Can a bicep tendon tear heal without surgery?
Partial tears often heal with rest, physical therapy, and regenerative treatments like prolotherapy. Complete tears, especially in active individuals, may require surgery for full function.
Is prolotherapy safe and effective for bicep tendon tears?
Yes, prolotherapy is considered safe when performed by experienced practitioners and has shown positive outcomes for tendon injuries in clinical studies.5
How long does recovery take after a bicep tendon tear?
Recovery varies: partial tears may heal in 6-12 weeks, while complete tears (especially after surgery) may take 3-6 months or longer.
When should I see a specialist?
If you have sudden pain, weakness, bruising, or a visible bulge in your arm, see a specialist promptly for diagnosis and treatment.
Contact ProHealth Clinic Today for Your FREE 15-Minute Discovery Call
Don’t let bicep tendon tears control your life any longer. Join the thousands of patients who have found lasting relief through prolotherapy at ProHealth Clinic.
Get in Touch
- Phone: +44 1234 380345
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- London: 104 Harley Street, Marylebone, W1G 7JD
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Author Bio
Having performed over 10,000 procedures, Mr Oliver Eaton is one of the UK’s leading practitioners in the field of treating bicep tendon tears, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with bicep tendon tears and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
Mr Eaton’s expertise has been featured in many national news and media publications, including The Telegraph, The Daily Mail, The Daily Express, Women’s Health Magazine, and The Scotsman.
Connect with Oliver Eaton on LinkedIn
References
- Ahrens PM, Boileau P. The long head of biceps and associated tendinopathy. J Bone Joint Surg Br. 2007;89(8):1001-1009. View Study
- Elser F, Braun S, Dewing CB, Giphart JE, Millett PJ. Anatomy, function, injuries, and treatment of the long head of the biceps brachii tendon. Arthroscopy. 2011;27(4):581-592. View Study
- Chew FS, Giuffrè BM. Imaging of the biceps brachii tendon. AJR Am J Roentgenol. 2005;184(2):507-517. View Study
- Cain PR, Mutschler TA, Fu FH, Lee SK. Anterior shoulder pain and the biceps tendon. Clin Sports Med. 1989;8(4):741-749. View Study
- Rabago D, Slattengren A, Zgierska A. Prolotherapy in Primary Care Practice. Prim Care. 2010;37(1):65-80. View Study
Disclaimer: This article is for informational purposes only and does not substitute for professional medical advice. Always consult your healthcare provider before making treatment decisions.