Proximal biceps tendon injury

Last revised by Dr Joachim Feger on 04 Dec 2021

Proximal biceps tendon injuries refer to biceps injuries at the level of the shoulder and usually affect the long head biceps tendon. They comprise strains, partial and complete tears. 

Proximal biceps tendon injuries account for about 96% of all biceps injuries 1.

Conditions that account as predisposing factors for proximal biceps tendon injuries include the following: 

  • advanced age
  • overhead activity
  • corticosteroid use
  • smoking

Proximal biceps tendon injuries are associated with other shoulder pathologies including:

The diagnosis of a distal biceps tendon rupture can be established by a combination of clinical features and characteristic imaging findings.

Proximal biceps tendon injury is a common source of shoulder pain 1,2. Tendon rupture additionally results in elbow flexion and/or forearm supination weakness and might result in a characteristic ‘Popeye deformity’ with the muscle retracting and moving causally 1.

The biarticular configuration and the high amount of fast-twitch (type II) muscle fibers of the biceps muscle are considered risk factors for biceps injury. The long head biceps tendon is most frequently affected by far 2.

The most common sites of proximal biceps tendon injury are 1:

  • tendon origin at the superior glenoid labrum
  • the musculotendinous junction at the exit of the bicipital groove

Features that can help diagnose proximal biceps tendon ruptures include:

  • absence of the tendon or tendon retraction
  • fluid-filled tendon sheath
  • muscle edema: non-specific 
  • muscle atrophy: non-specific 

Surgical treatment includes biceps tendon tenotomy or tenodesis.

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Cases and figures

  • Case 1: rupture involving long head
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  • Case 2 : proximal long head rupture
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  • Case 3: proximal long head on arthrography
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  • Case 4: proximal biceps tendon tear
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