Biceps Tendon Tear in Vienna
A snap in the upper arm or in the crook of the elbow, then bruising and a changed muscle contour — that is usually how a biceps tendon tear begins. It affects either the long head of the biceps tendon at the shoulder or the distal biceps tendon at the elbow; the two differ clearly in urgency and in treatment. At my practice in Vienna-Döbling I establish which one it is.
In short
In a biceps tendon tear, one of the tendons that connect the biceps (the two-headed muscle of the upper arm) to the skeleton gives way. If the long head of the biceps tendon at the shoulder tears, the muscle belly slips downwards and forms the typical bulge on the upper arm (Popeye sign). If the distal biceps tendon at the elbow tears, what is missing above all is strength when bending and turning the forearm outwards — that should be assessed quickly, because the tendon retracts. I make the diagnosis from the conversation, the clinical examination and ultrasound, supplemented by an MRI where needed. As a rule I reattach the distal tendon to the radius, while I often treat the long head of the biceps tendon conservatively; the findings, the timing and the load you place on the arm decide the route.
What is a biceps tendon tear?
The biceps is anchored to the skeleton at three points. At the top, two tendons run to the shoulder: the long head of the biceps tendon passes through the shoulder joint and is guided in its groove by a ligament complex, the pulley. At the bottom the muscle continues into the distal biceps tendon, which attaches to the radius and bends the forearm and turns it outwards.
The long head of the biceps tendon usually tears after prolonged wear: the pulley loosens, the tendon becomes unstable (pulley lesion), chafes and finally gives way. Such tears often occur together with a rotator cuff tear — which is why, as a shoulder specialist in Vienna, I always assess the whole joint.
The distal biceps tendon, by contrast, tears abruptly when the bent arm is suddenly straightened: when catching a load or lifting weights. I see a similar pattern with a pectoralis tendon rupture in strength sports.
Typical symptoms
- Snap or pop — clearly felt at the moment of injury.
- Bulge and dent on the upper arm — the Popeye sign; the contour of the muscle changes visibly.
- Bruising — on the upper arm or in the crook of the elbow, often visible only after a delay.
- Loss of strength when turning outwards — when opening a bottle, for instance; typical of the distal tear.
- Pain at the front of the shoulder — with the long head of the biceps tendon, often stronger before the tear than after it.
- Cramp-like pulling in the upper arm — under load, after a tear of the long tendon.
Such injuries often arise during training; more on this under sports orthopaedics in Vienna.
How I make the diagnosis
At the beginning there is the conversation: how did it happen, was there a snap, since when has the strength been missing? The clinical examination follows, with targeted strength and function tests at the shoulder and at the elbow. Ultrasound is available in the practice — with it I assess the tendon while it moves and separate a complete tear from a partial one. Where needed I arrange an X-ray or an MRI; both take place outside the building, and I go through the reports with you afterwards.
Distal biceps tendon at the elbow: almost always surgical
If the distal biceps tendon at the elbow tears, I discuss reattachment (refixation) promptly; only rarely do I treat it conservatively. Without refixation, strength is permanently missing when bending the arm and above all when turning the forearm outwards, because at the elbow no second strand of tendon takes over the task. For athletically and physically active patients I plan the refixation without delay, because anyone who relies on full rotational strength again at work or in strength training benefits from a tendon that is repaired while fresh, before it has scarred.
Because this tear belongs to the elbow and carries an urgency of its own, I have described it at length on a page of its own: the torn distal biceps tendon at the elbow — how the tear happens, how the refixation proceeds, the rare conservative cases and the aftercare. Treatment at the elbow I accompany as an elbow specialist in Vienna.
Long head of the biceps tendon at the shoulder: often conservative
A tear of the long head of the biceps tendon at the shoulder, by contrast, can often be treated conservatively, because the remaining parts of the muscle take over some of the work; the changed contour on the upper arm does, however, remain. For that the following are available to me:
- physiotherapy and exercise therapy, both in the same building at the Orthozentrum Döbling
- an ultrasound-guided injection where the irritation is pronounced
- shockwave therapy, focused and radial, for a persistently irritated tendon insertion
- PRP therapy for partial tears and irritated states of the tendon
- magnetic field therapy as an accompanying measure
At the shoulder, tenodesis comes into consideration as the surgical option: here I fix the long head of the biceps tendon to the humerus, outside the joint, by means of an arthroscopy (joint inspection through small approaches). That makes sense when the tendon has become unstable through a pulley lesion and is causing pain — in people who are active in sport and place high demands on the shoulder, I raise this route earlier.
Procedure, locations and billing
I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. I have described how a private practice works on a separate page. Whether an operation makes sense depends on the findings; we take the decision together.
Frequently asked
Common questions about a biceps tendon tear
Typical is a snap under load, followed by pain, bruising and a changed contour of the upper arm. If the long tendon at the shoulder tears, the muscle belly slips towards the elbow. If the distal tendon at the elbow tears, what is missing above all is strength when bending and turning the forearm outwards. Only the examination brings certainty, because partial tears begin in a similar way.
That is the name for the conspicuous bulge on the upper arm that appears when the torn tendon no longer holds the muscle belly. With a tear of the long head of the biceps tendon it moves towards the elbow, with a distal tear towards the shoulder. The sign is a clear pointer, but it does not replace the examination.
That depends on which tendon has torn. As a rule, I treat a tear of the distal biceps tendon at the elbow surgically; only rarely do I treat it conservatively, for instance with low demands on rotational strength or when coexisting conditions argue against the procedure. A tear of the long head of the biceps tendon at the shoulder, by contrast, can often be treated conservatively, because the remaining parts of the muscle take over some of the work. The findings, the timing and your demands decide.
That can usually be told from where it hurts and from the contour of the upper arm. With the long head of the biceps tendon the pain sits at the front of the shoulder joint, and the muscle belly slips towards the elbow. With the distal tendon, pain and bruising sit in the crook of the elbow, the muscle belly moves upwards, and rotational strength is missing. The examination and the ultrasound settle which it is.
The pulley is a ligament complex that guides the long head of the biceps tendon in its groove at the entrance to the shoulder joint. If it is damaged, the tendon becomes unstable, jumps out of its guide and chafes. That hurts at the front of the shoulder and can precede a tear. Frequently there is damage to the rotator cuff at the same time.
The aim of treatment is to restore strength and mobility as far as possible and to make a return to your sport possible. How the build-up proceeds depends on which tendon was affected and on whether surgery was performed. I set out the increase in load with you and with physiotherapy and adapt it as recovery goes on.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. For operations, direct settlement with supplementary private insurance is possible.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.