What are biceps tendon injuries?
The biceps is the muscle at the front of the upper arm. Tendons attach it to bone at both ends. It bends the elbow and turns the palm up.
At the shoulder end, called the proximal end, the long head of the biceps runs through a groove in the arm bone and attaches inside the joint at the labrum. At the elbow end, called the distal end, the tendon attaches to the forearm.
These two ends get different injuries and need different plans.
What is proximal biceps tendinitis?
This is irritation or wear of the long head tendon at the shoulder. It causes pain at the front of the shoulder, often with lifting, reaching overhead, or at night. It often comes along with a rotator cuff tear or a labral tear, so the exam looks at the whole shoulder.
Treatment usually starts with rest from painful activity, anti-inflammatory medicine if safe for you, and physical therapy. An injection may be an option. Many people improve without surgery.
What happens if the biceps tears at the shoulder?
Many people feel a pop or a sudden pain. The muscle may bunch up toward the elbow, which is called a Popeye deformity. Some people find that the shoulder hurts less afterward, because the painful tendon is no longer under tension.
Many of these tears are treated without surgery. Cramping and a change in the shape of the arm are common concerns. Whether to treat it further depends on your symptoms, your work, your sport, and any other shoulder damage.
What is the difference between tenotomy and tenodesis?
If pain continues, surgery may treat the tendon in one of two ways.
- Tenotomy means cutting the tendon where it attaches inside the joint, and letting it settle down the arm.
- Tenodesis means cutting the tendon there and fixing it to the arm bone, so the muscle keeps its length.
A review of 11 randomized trials and 860 patients found similar function and pain scores between the two. Tenodesis led to a lower rate of the Popeye deformity, and tenotomy took less time in the operating room. Apart from appearance, the authors found no significant clinical benefit from tenodesis (Hartland, 2022).
Many younger, active people and those who care about the shape of the arm lean toward tenodesis. This is a choice to talk through. The same procedure can also be used for some SLAP tears.
What is a distal biceps tear?
This is a tear at the elbow, usually a sudden event. It often happens when the arm is forced straight while lifting or catching something heavy. People feel a pop at the front of the elbow, then bruising, and the muscle moves up the arm. Turning a key or a screwdriver may feel weak.
In one review of distal biceps repair, 99.2% of patients were men, and the mean age was 44.9 (Boufadel, 2025).
Get this checked soon. The tendon can pull back and scar over time, and that can make repair harder. Your exam and an MRI or ultrasound can show whether the tear is partial or complete.
Do I need surgery for a distal biceps tear?
Not everyone does, but surgery is often advised for active people with a complete tear. A review of 53 studies and 1,380 patients compared strength with the uninjured arm. After surgery, flexion strength was 94.7% and supination strength, the turning motion, was 89.2%. Without surgery, those figures were 83.0% and 62.6% (Cuzzolin, 2021). Function scores also favored surgery. People with lower demands or major health concerns may still choose non-surgical care.
In surgery, the tendon is reattached to the forearm bone through one or two incisions, using a small implant or bone tunnels.
Can I go back to sport after distal biceps repair?
A review of 1,093 patients found that 91.5% returned to sport, and 85.2% returned to their earlier level or higher, at a mean of 6.3 months (Boufadel, 2025). Those are group averages, not a promise for any one arm.
What are the risks of surgery?
At the shoulder, risks include infection, stiffness, ongoing pain, cramping, and failure of the fixation.
At the elbow, a review of 3,091 repairs found an overall complication rate of 25%, and most were minor. The most common was injury to a skin nerve of the forearm, in 9.2%. Major complications occurred in 4.6%, including a motor nerve injury in 1.6% and rerupture in 1.4%. Most nerve injuries got better without further treatment (Amarasooriya, 2020). No surgeon can promise a certain outcome.
Should I get a second opinion?
It can help, especially if you were told it is too late to repair your elbow, or if you are weighing tenotomy against tenodesis. Here’s how a second opinion works.
Where can I see Dr. Pareek?
Dr. Pareek sees patients with biceps injuries at HSS in New York and at HSS in New Jersey. Bring any X-rays, MRI images, and reports you already have.
What does recovery look like?
These are typical ranges. Your surgeon’s plan comes first, and recovery varies from person to person.
- Weeks 0-2: Rest and protectAfter surgery, many people use a sling or brace and focus on pain, swelling, and moving the hand and wrist. Your limits depend on whether the shoulder or the elbow was treated.
- Weeks 2-6: Regain motionPhysical therapy builds gentle motion. Lifting with the arm is usually limited while the tendon heals to bone.
- Weeks 6-12: Start strengthLight strength work begins as your plan allows. Everyday tasks usually get easier in this phase.
- Months 3-6: Build powerStrength work gets harder, with a gradual return to lifting, work tasks, and sport drills.
- Months 6 and beyond: Return to full activityMany people return to sport around this time, once strength allows. These are typical ranges, and your surgeon's plan governs.
Sources
- Hartland AW, et al. Clinical effectiveness of tenotomy versus tenodesis for long head of biceps pathology: a systematic review and meta-analysis. BMJ Open 2022;12:e061954.
- Cuzzolin M, et al. Operative versus nonoperative management for distal biceps brachii tendon lesions: a systematic review and meta-analysis. Orthop J Sports Med 2021;9:23259671211037311.
- Amarasooriya M, et al. Complications after distal biceps tendon repair: a systematic review. Am J Sports Med 2020;48:3103-3111.
- Boufadel P, et al. Return to sport after distal biceps tendon repair: a systematic review. Am J Sports Med 2025;53:1769-1778.