Overview
what it is and why it matters
Rupture of the long head of the biceps tendon at the shoulder is usually a final event in a tendon weakened by years of tendinopathy. It typically occurs spontaneously or with a minor lifting effort in men over 50. The tendon retracts into the arm, producing the characteristic "Popeye" deformity — a bulge in the mid-upper arm. The short head of the biceps remains intact, so most patients retain reasonable supination strength and experience marked improvement in shoulder pain.
Diagnosis
exam first, imaging secondSudden anterior shoulder pain with a "pop," followed by ecchymosis tracking down the upper arm. The Popeye deformity is visible on elbow flexion. Hook test (inability to hook a finger behind the biceps tendon at the antecubital fossa) distinguishes distal from proximal rupture. MRI confirms the diagnosis and evaluates associated rotator cuff pathology.
Treatment Path
how care progresses at OSI1
Non-operative management
Appropriate for most older, lower-demand patients — the shoulder pain typically resolves, and most daily function is preserved. The cosmetic deformity and mild strength loss are often acceptable.
2
Physical therapy
Shoulder strengthening once the acute pain settles.
Surgical Options at OSI
if non-operative care isn't enoughSurgical repair (tenodesis) is considered in younger, active patients who require full supination strength, in workers with manual labor demands, and in patients who find the Popeye deformity unacceptable.
Providers Who Treat Biceps Tendon Rupture
sports-medicine team
David B. Templin, M.D.
Trent Twitero, M.D.
Further Reading
authoritative sourcesExternal patient-education references and related OSI pages for additional background: