What are the Types of Biceps Tendon Injuries at the Elbow?

The biceps tendon is a bipennate (two heads) tendon that attaches the biceps muscle to the radius in the forearm. Its main action is to supinate (forcefully rotate the palm up) and flex the elbow. Biceps tendonitis and complete biceps rupture are the two types of injuries. They are likely both part of the same disorder. The tendon insertion on the radius has a poor blood supply and therefore, may become injured through use or with age.

Symptoms & Causes

Inflammation, due to the body’s attempts at healing this tendon, can cause pain. Conversely, a frank rupture can occur. Sometimes there is a presenting period of pain in the anterior elbow before the tendon pops, but most of the time, it is just a sudden tear of the tendon.

Affected Populations

Typically, weekend warriors get biceps ruptures. They are almost always male between the ages of 35-60. Steroids can also be implicated. Biceps tendonitis is less common or at least less diagnosed. These can be in men and women and present with anterior elbow pain, pain with lifting, and pain with gripping. There may or may not be an inciting injury.


A complete rupture is usually obvious if the tendon retracts up the arm. Often, a tight band of tissue in the arm prevents the tendon from retracting after the injury. There will be significant pain, swelling and often subcutaneous bleeding. An MRI is diagnostic. Tendonitis is diagnosed with a physical examination: pain with resisted supination, pain when pushing on the biceps tendon, and pain with resisted flexion. In addition,x-rays and MRIs are essential in making the diagnosis and ruling out other problems like radial nerve irritation.


Biceps ruptures are usually treated surgically. Non-surgical evaluations of patients show that not repairing a biceps tendon at the elbow can result in up to a 70% loss in supination strength and a 40% loss of elbow flexion strength. With the advent of new surgical techniques and hardware, surgeons can reattach the biceps through a drill hole in the bone with excellent results.

Chronic, long-standing biceps tendon ruptures can be treated surgically. While most orthopedic surgeons won’t treat a biceps tendon rupture after two to three weeks. We have treated patients as late as six years after injury. Ideally, we would treat patients earlier but sometimes they present late for a myriad of reasons. For chronic injuries, we use a tendon graft, either from the patient’s leg or more commonly from a tissue bank. The reason for surgical treatment late is continued pain or weakness. The cosmetic deformity may persist, but strength will improve.

Complications of surgical treatment increase with time from injury to surgery. This means time is of the essence for surgical treatment for acute ruptures.

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