There are two heads to the biceps brachii, the long head (that goes from the labrum to just past the elbow…the outside one in the picture) and the short head (that goes from the coracoid process to just below the elbow…the inside one in the picture).  We rely on each muscle for shoulder flexion, elbow flexion, and some supination (hand rotated upward) of the forearm/wrist/hand.  Of the two heads, the long head tends to tear more as it thins out as it travels into the shoulder and it is more susceptible to damage at its attachment on the shoulder labrum.

The muscle can tear due to age-related wear and tear, labral tearing, overuse and trauma.  Generally, muscles tear from either the origin (where it begins proximally), or the insertion (the distal attachment).  When the biceps tears from the insertion, it will tend to roll up the arm and form a ball in the middle of the biceps region.  This type of tear tends to be very noticeable.

The two heads (long and short) of the biceps brachii muscle

When the origin tears, it more-so ‘flops’ down in the direction of the insertion, but it does not ‘ball’ up as much. This tear is more difficult to diagnose and usually imaging, such as an MRI, is needed.

When a distal tear of the biceps occurs, it can be surgically repaired.  Although many people can do fine without the surgery, the more athletic population tends to opt for the surgical correction.  Generally, the surgery will be done immediately or after some time, to allow the swelling and inflammation to go down sufficiently (several weeks). Newer techniques in orthopedics place the biceps tendon origin NOT at the same location it tore from.  This technique is called a biceps tenodesis.  With this procedure, the biceps is not reattached on the supraglenoid tubercle (labrum) but is rather moved to the side a bit.  This is done so that the biceps can no longer exert tension on the labrum and this helps reduce tearing of the biceps and the labrum.

So, how do you know if you may have torn your biceps?  Well, many things can signal a tear:

1.  You can feel a sharp pain and/or snapping noise as the biceps tears
2. If the insertion tears, there will be a balling up of the muscle in the middle of the biceps region (remember, usually only one of the two heads will tear)
3. Pain will be felt in the region where it tears
4. Weakness or faster fatigue will be felt when flexing the shoulder and/or elbow
5. Bruising is usually seen in the medial (inside) portion of the biceps muscle region, indicating internal bleeding from the tear
6. In some cases, because the biceps works to supinate, or turn the palm upward, this movement can hurt as can turning the hand downward, which is called pronation

I am writing about this topic as I have seen more and more biceps tears over the last few years and there is not a lot of good single site references that detail this issue.

Should you think you might have partially or fully torn your biceps, by all means, get it checked out by someone trained in sports injury assessment, such as sports chiropractor or orthopedist.

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