The biceps muscle has 2 tendons at its origin; the long tendon which attaches to the glenoid and the short tendon which attaches to the coracoid process. It inserts distally via another tendon onto the radial tuberosity. A biceps tendon rupture is when one of these tendons separates from its attachment site or is torn across it's full width. This most frequently occurs at the long tendon (90%), but rarely can occur in the distal tendon (10%).


  • Incidence: 1.00 cases per 100,000 person-years
  • Peak incidence: 40-50 years
  • Sex ratio: more common in males 8:1
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Clinical features

Patients typically report the following symptoms/signs:
  • A sudden 'pop' or tear either at the shoulder (long tendon), or at the antecubital fossa (distal tendon) which is followed by pain, bruising and swelling
  • Rupture of the proximal tendon causes 'Popeye' deformity; this is when the muscle bulk results in a bulge in the middle of the upper arm. Seen more easily in muscular individuals and less obvious in overweight or cachectic patients
  • Rupture of the distal tendon can cause 'reverse Popeye' deformity but this is not a reliable sign.
  • Weakness in the shoulder and elbow typically follows including difficulty with supination
  • Some patients who may have had chronic shoulder pain prior to tendon rupture might notice an improvement in their pain.


  • Start with a basic examination, palpate the long head and distal biceps tendon and assess neurovascular function the upper extremities
  • The biceps squeeze test: If it is intact then a squeeze will cause forearm supination
  • Musculoskeletal ultrasound by a skilled clinician and should always be the first investigation for suspected biceps tendon rupture
  • For suspected long head biceps tendon rupture there is little role for further imaging given the conservative management. However MRI can be considered if there is a limited examination or likely concomitant pathology.
  • For suspected distal biceps tendon rupture, an urgent MRI should be performed as a diagnosis on clinical signs alone is challenging, and this usually requires surgical intervention.