You might have a biceps tendon rupture if you experience a sudden sharp pain in your arm or shoulder, followed by weakness or bruising. This injury occurs between your biceps muscle and your shoulder or elbow bones. Biceps tendon rupture can make it difficult to lift, grip, and move without pain. Suffering a bicep tendon rupture is frustrating if you are active or need to use your arms daily.

Consult a physical therapist for diagnosis and treatment to relieve your pain. At Suarez Physical Therapy, we specialize in physical therapy to help you regain strength, flexibility, and confidence. If you are looking for a biceps tendon rupture physiotherapist in Las Vegas, we are here to provide expert therapy services.

Anatomy of the Biceps Tendon at the Shoulder

The biceps muscle’s primary function is flexing the elbow and rotating the forearm. The tendons that link this muscle to the bones do most of the work in regular, high-intensity movements. The biceps muscle attaches to bones through two distinct tendons at the shoulder, including the short and long head.

The most susceptible tendon is the long head. It attaches to the top of the shoulder blade at a bony ridge called the glenoid. This tendon passes through the shoulder joint and connects to the bone, supporting the weight of lifting or throwing. This delicate positioning within the joint makes it prone to wear and tear under repeated stress, increasing the chance of a rupture.

The short head tendon is attached to a region near the coracoid process. Due to its shorter path and lesser load-bearing role, it is less vulnerable to rupture than the long-head tendon.

The distal biceps tendon is a third, smaller tendon. It attaches the biceps to the radius bone in the forearm. Despite not being part of the shoulder anatomy, it allows forearm rotation and elbow flexion. An injury to the distal biceps tendon can also cause a significant reduction in your arm function.

What Is a Biceps Tendon Rupture?

Biceps tendon rupture occurs when you tear the fibrous tissue that attaches the biceps muscle to the bone, usually from an injury or long-term degeneration. Tendons link the muscle to the shoulder and elbow joints, stabilizing and driving the arm’s complex range of movements.

When a rupture occurs, you feel an abrupt snap, followed by pain, weakness, and often a visible deformity. The deformity is commonly known as the "Popeye sign" due to the biceps muscle bunching up.

The injury is often near the shoulder or elbow but can occur anywhere. Therefore, each location has implications, with different symptoms and treatment approaches. Sometimes, the tear may be complete when the entire tendon is torn, and the remaining fibers cannot function. However, a complete rupture is a complete detachment from the bone, and that causes more limitations.

Biceps Tendon Rupture Near The Shoulder

A biceps tendon rupture at the shoulder usually involves the long head of the biceps tendon. This head is more prone to normal tear and wear as it is in the shoulder joint. Such a rupture usually occurs from degenerative changes rather than from a sudden, traumatic injury.

Repeated shoulder movements over time, particularly in tasks where the shoulder needs to move overhead, like throwing or lifting, can wear down the tendon. A tear occurs as the tendon frays; even a slight movement can cause pain immediately and reduce arm strength.

You might feel a 'pop,' pain radiating down the arm, and swelling and bruising around the shoulder. Some patients have partial arm function with intact short head tendon, but the injury limits range and strength and complicates everyday activities. Treatment depends on how much of the rupture is present, with conservative physical therapy being the treatment of choice if function is to be restored.

Biceps Tendon Rupture Near The Elbow

A biceps tendon rupture near the elbow involving the distal biceps tendon is less common but typically more disabling than a shoulder tear. Distal biceps ruptures are different from shoulder ruptures. They are commonly caused by gradual degeneration and occur abruptly. Usually, it is a forceful activity, such as lifting a heavy object with a stretched arm, that suddenly puts a load on the tendon that snaps away from the radius bone in the forearm.

A rupture results in immediate pain, bruising, and a visible 'gap' in the elbow. There is also a huge loss of strength, especially in the rotation of the forearm and flexion of the elbow. Unlike shoulder ruptures, with a distal rupture, there is no other tendon to assist in providing biceps function in the lower arm. Therefore, it is difficult to regain full movement without surgical repair.

Surgery is often recommended to reattach the tendon and return strength to those who wish to return to an active lifestyle. However, physical therapy alone may help improve function.

Biceps Tendon Rupture Symptoms

The onset of symptoms is most often abrupt and unmistakable. Many people report hearing or feeling a “pop” when the tendon has torn away from its attachment to the bone, which signals that the tendon has ruptured. Once it comes, this sensation is followed by sudden, sharp pain that often radiates down the arm, usually just near the affected shoulder or elbow joint.

Soon, the muscles and surrounding tissues become swollen, and the injured area rapidly turns deep purple along the path of the severed tendon. The bruising may extend down the arm within hours to days. With the biceps muscle displaced, it clumps above the upper arm. That is why, in the case of its detachment, it is given the slang name of “Popeye deformity.”

In addition, the biceps muscle tendon ruptures are accompanied by decreased muscle strength. Scooping, turning the hand around an object, or bending the elbow to bring it towards the shoulder becomes challenging, sometimes unbearable.

The loss of strength depends on where the rupture occurs. If the tear is at the shoulder, you might retain some function because of the remaining intact tendon. However, if the rapture is near the elbow, where no other tendons can assist, you will likely experience a more pronounced weakness, particularly when twisting your forearm.

Biceps Tendon Rupture Causes

A sudden strain and gradual wear to the biceps tendon usually leads to a biceps tendon rupture.

As you age, your body’s tendons naturally lose their elasticity and strength and are more likely to tear.

Activities that place a lot of pressure on your biceps tendons, such as lifting heavy objects with your arms extended or reaching awkwardly overhead, can be intense on these fibers. If weakened, this additional load may cause the tendon to snap. This is the unfortunate moment for many when a rupture occurs, a sudden, forceful pull that the weakened tissue cannot withstand.

Long-term degeneration is also a primary factor beyond acute injury. Daily activities, especially those using repetitive shoulder or elbow movements, slowly remove the biceps tendon fibers. As time passes, micro tears build up, and the tendon becomes less resilient until it starts to fray and can break even with the slightest movement or twist.

Chronic conditions such as rotator cuff tears, tendonitis, or impingement syndrome increase the risk. These conditions add ongoing pressure to the tendons, making a rupture more likely. Sudden or gradual, each of these factors highlights the complexity of biceps tendon injuries and the importance of knowing one’s own risk.

Risk Factors For Biceps Tendonitis

Certain factors increase your risk of developing biceps tendonitis, which often precedes a complete rupture. These factors are:

  • Tendon elasticity decreases with age. Therefore, injuries are more likely after age 40. Your tendons at this stage of life are not as resilient and are more likely to accumulate the effects of minor strains and injuries.

  • Repetitive overhead motions such as those found in sports like baseball, swimming, and tennis. Repeated movement causes stress on your tendons, a small amount with each movement, which, over time, weakens your tendons.

  • Athletics or jobs that require labor, such as repetitive lifting or throwing.

  • Having rotator cuff issues in the past.

  • Smoking. Studies show that nicotine decreases blood flow to tendons, slowing tissue repair and causing tendon degeneration with time.

  • Underlying conditions. Specific health conditions such as diabetes are a risk factor. Poor collagen synthesis and reduced tendon resilience are associated with diabetes, which increases the risk of injury in people with diabetes.

Diagnosis and Tests

Your physical therapist or healthcare provider will examine you to determine the extent of the injury and whether the surrounding tissue is healthy. This process involves physical exams and imaging tests.

Physical Exams

During a physical exam, your physical therapist will examine your shoulder and arm, checking several areas. Limited movement can mean problems with your tendons or muscles, so your physiotherapist will evaluate the range of motion of the shoulder and elbow.

Your provider will also check for tenderness along the front of the shoulder, where the biceps tendon attaches. Pain or sensitivity here is a common sign of a tear or inflammation.

Along with a range of motion and tenderness, your therapist will also check for bruising around the upper arm or shoulder. After a tendon rupture, blood pools in the area, causing it to look bruised and swollen.

Also, your therapist will perform a strength test to see how much your biceps can move and how much force you can generate. The therapist will watch if you can flex or rotate your forearm and if a ‘Popeye muscle’ deformity (the biceps muscle bulging back into place where it should be) is present, a sign of tendon rupture.

Imaging Tests

Imaging tests give you the clarity to obtain a definitive diagnosis. In initial evaluations, x-rays are often used not because they show tendon injuries directly but because they reveal fractures or bone problems that might be causing your symptoms.

If the X-ray is inconclusive, an ultrasound may be performed. Ultrasound imaging can visualize soft tissues and partial or complete biceps tendon tears can be seen.

Your physical therapist might order an MRI (magnetic resonance imaging) for a more detailed view. An MRI is a cross-sectional look at both soft and hard tissues and can tell your healthcare provider exactly where the tear is, how big it is, and how severe it is. This helps determine whether surgery or conservative treatment would be best.

Sometimes, your provider may also suggest a CT scan, especially if they need to look at any structural problems with the shoulder or elbow joint. A CT scan gives a clear image of bones, tendons, and muscles, providing more insight into any damage the rupture might have caused.

Creating an effective treatment plan to treat the rupture and any other injuries requiring attention requires these diagnostic steps, from physical exams to advanced imaging.

Management and Treatment Through Physical Therapy

A customized physical therapy plan can heal and strengthen the arm, restoring full function to help you feel confident returning to daily activities.

Rest

Rest helps reduce strain on the damaged tendon. After injury, you want to limit movement of the affected arm, avoid heavy lifting, and do repetitive activities that can aggravate the tear. During rest, your body’s natural healing process begins.

Your physical therapist will help you decide how much rest is needed and may suggest a sling or similar support device to keep the arm still and off the arm while it is healing early on.

Icing

Ice packs on the front of your shoulder constrict blood vessels to reduce inflammation and numb the area to relieve pain. Ice works best in intervals, 15 to 20 minutes at a time, 3 to 5 times a day. Your physical therapist may suggest icing protocols that work best for your pain levels and swelling patterns, a simple yet powerful tool for symptom management.

Range-Of-Motion Activities

After initial pain and swelling have subsided, your therapist will guide you through a gentle range of motion exercises. Doing these exercises keeps the shoulder and elbow flexible; otherwise, you can suffer from stiff or frozen shoulders if you do not do them.

These activities may begin with small, controlled arm movements to help you regain the ability to bend and straighten the arm completely. Over time, your therapist will add range and complexity to these movements, watching you closely to see how your joint mobility is restored without putting too much stress on the healing tendon.

Strengthening Exercises

A gradual strengthening program will start as your shoulder’s range of motion improves. Strengthening exercises help rebuild muscle and tendon resilience and support your biceps and surrounding muscles to prevent re-injury.

In the early part of this phase, you may use resistance bands or light weights and do controlled, low-intensity movements that will not overload your healing tendon. These exercises will become harder over time as the biceps and shoulder work to regain full strength and support.

Your physical therapist will closely monitor your progress and modify the exercises to ensure safe and effective recovery.

Patient Education

Your physical therapist will teach you how to prevent injury in the future, warning you against overstretching your tendons. This may include advice on how to lift correctly, maintain correct posture, and change your activity to protect your biceps and shoulder.

They will also teach you how to recognize the early stages of tendon stress so that you can address problems before they become full-blown injuries. This is an investment in your future long-term health and resiliency.

Surgical Treatment Or Biceps Tenodesis

If non-surgical methods, such as physical therapy, do not fully relieve pain or restore function after a biceps tendon rupture, then surgery may be recommended. Biceps tenodesis is a surgical option for patients with persistent symptoms or specific tendon tears, in which the biceps tendon is secured to the humerus bone.

The two types of surgical techniques include:

  1. The Soft Tissue Technique

The soft tissue approach involves securing the tendon by suturing it directly to nearby soft tissue, the natural anchor. However, this technique may be more appropriate for less severe ruptures where securing the tendon within the existing tissue structure is enough for stability.

  1. The Bone Anchor Method

The bone anchor method is usually preferred for larger or more severe tears. This approach uses a specialized anchor that attaches the tendon directly to the humerus bone, resulting in a more stable and long-lasting fixation.

Physical Therapy After surgery

After biceps tenodesis, an organized physical therapy plan is needed to achieve effective recovery, range of motion, and strength recovery. Your physical therapist will teach you gentle exercises early on after surgery to remove stiffness and move your arm slowly. Exercises could include:

  • Hand squeezing.

  • Gentle shoulder shrugs.

  • Supported pendulum exercises.

Your therapist will gradually introduce more advanced exercises, including:

  • Full pendulum movements.

  • Controlled elbow and wrist activities.

Doing these exercises helps improve flexibility while your tendon and surrounding muscles recover.

You will start resistance exercises to build up the shoulder and biceps as you heal—for example, rotator cuff and elbow strengthening exercises with resistance bands or light dumbbells.

You will do wall push-ups, elliptical training, and light pool-based exercises as you go along.

Your physical therapist will gradually intensify your exercises as you build strength and stability.

In the end, exercises like resistance training in a seated rowing machine, treadmill running, and even weight training with light weights will help your shoulder prepare for regular physical demands.

Find a Las Vegas Biceps Tendon Rupture Physical Therapist Near Me

Recovering from a biceps tendon rupture takes time, hard work, and a skilled physical therapist. Whether it is surgery or a well-thought-out, focused regimen of nonsurgical rehabilitation, work closely with a qualified physical therapist to regain strength and full range of motion.

At Suarez Physical Therapy, we have knowledgeable therapists who will thoroughly guide your tailored rehabilitation program, ensuring that you do not re-injure your shoulder and are set up for sustained shoulder health.

If you seek a dedicated physiotherapist in Las Vegas, call us at 702-368-6778 to schedule an appointment.