Physical Therapy for Bicep Tear

We tend to think of big bulging bicep muscles as a sign of strength and may take for granted the role that this upper arm muscle plays until faced with an injury. When suffering a bicep tendon tear or rupture you may wonder if you will ever regain your former level of function and how long it will take to recover if surgery is indicated. To better understand this type of injury, it helps to learn about the bicep and how it functions.

Anatomy of a Bicep

The bicep muscle is a long muscle that runs along the front of the upper arm. It is connected to the scapula (shoulder blade) and the radius (at the elbow) by two tendons. These two tendons, which are tough bands of tissue, connect muscle to bone and are called the long head and the short head tendon.

How Does Injury Occur?

Injury is often seen in individuals who engage in heavy lifting due to sports or work activities such as lifting heavy boxes. The flexion of the bicep at the time that force is exerted also plays a role in tearing a bicep tendon as the stress/strain curve graph shows.

Symptoms could include:

  • Pain
  • Bruising
  • Popeye arm, a contracted ball like deformity of the bicep muscle
  • An audible pop/snap sound

How to Differentiate Between a Distal Versus Proximal Bicep Tear?

British Columbia Medical Journal reports that bicep tendon tears occur most commonly in middle-aged men and that 96% involve a tear of the long head tendon. The following symptoms may be seen according to the site of injury.

Proximal Rupture

  • Pain, swelling and bruising in the upper arm and shoulder
  • Mild weakness or cramping when flexing or extending the upper arm
  • Popeye sign

Distal Rupture

  • Black and blue bruising and/or swelling of the antecubital fossa or the inner arm area opposite the elbow
  • Popping sound or sensation at the time of injury
  • Reverse Popeye deformity, muscle balling up near the shoulder

Diagnosing a Bicep Tendon Tear

Physical examination by your physician should be performed and if the injury is causing substantial pain, without great delay. According to OrthoInfo, your physician may determine that an x-ray, ultrasound, or MRI is necessary to rule out other potential pain-causing problems and for visualization of the torn tendon. Based on the diagnostic findings, your physician may recommend non-surgical options or perhaps a surgery called biceps tenodesis.

Non-Surgical Options

Pain relief and restoration of function will be the goal of conservative therapy. Rest of the affected arm and even use of the sling or immobilizer will assure the muscle and tendons have time to heal without risk of further injury. Over-the-counter NSAIDs may be prescribed to manage the pain. And then Physical Therapy may be used to aid in restoring the range of motion and maintenance of muscle strength.

Surgery and Post Surgical Care

If surgery is necessary, biceps tenodesis may be performed in which the torn tendon is reattached to bone with or without the use of metal hardware. Recovery can be expected in 3-4 months’ time and there may be activity restrictions advised such as no heavy lifting, driving, and use of an immobilizer.

The Role of Physical Therapy

Since the gradual reintroduction of strengthening and range of motion exercises will be needed in addition to adhering to physician-ordered limitations to allow for healing, the guidance of a trained therapist will be essential. A trained and qualified physical therapist will be able to guide you in your recovery and ensure a return to your baseline activity level. To see what services we offer and how we can be of service, please contact Cawley PT at 570-208-2787 or by email at