What is the treatment for a torn bicep?

Treatment for a Torn Bicep

For complete distal biceps tears in healthy, active patients, early surgical repair is recommended to restore supination strength and elbow flexion, while proximal (long head) biceps tears are primarily treated nonoperatively with adequate results. 1, 2, 3, 4

Initial Diagnostic Confirmation

Before initiating treatment, confirm the diagnosis and tear characteristics:

• Obtain plain radiographs first to rule out associated fractures or bony abnormalities at the radial tuberosity 1, 5, 6
• MRI without contrast is the preferred imaging modality with 86.4% accuracy for complete tears (compared to ultrasound's 45.5% accuracy), and is essential for distinguishing partial from complete tears 1, 6, 7
• Use the FABS (flexion-abduction-supination) view on MRI for optimal visualization of the distal biceps tendon 1, 5, 6
• Ultrasound has significant limitations (particularly for partial tears and tendinopathy) and should only be used when MRI is contraindicated 1, 5, 6

Treatment Algorithm Based on Tear Location and Severity

Proximal Biceps Tears (Long Head)

Nonoperative management is the primary treatment with adequate functional outcomes:

• Relative rest to decrease repetitive loading 5
• Oral NSAIDs for pain control 5
• This approach is appropriate because the long head functions primarily as a pain generator rather than providing critical biomechanical function 4

Distal Biceps Tears

Treatment depends on the extent of tearing:

Partial Tears <50%

Two treatment options exist:

• Conservative management: Relative rest and NSAIDs 5, 8
• Surgical debridement of surrounding synovitis if conservative treatment fails 8

Partial Tears >50%

Surgical repair is recommended: Division of the remaining tendon and repair of the entire tendon as a single unit 8

Complete Distal Tears

Early surgical reattachment to the radial tuberosity is recommended for optimal restoration of supination strength (primary function) and elbow flexion (secondary function) 2, 3, 4

Surgical timing considerations:

• Early repair (acute tears) provides optimal results with easier tendon mobilization 2
• Chronic ruptures can still benefit from surgical repair, but proximal retraction and scarring make mobilization difficult and may require tendon augmentation 2

Surgical technique options:

• Modified two-incision technique is most widely used 2
• Anterior single-incision techniques may be equally effective if the radial nerve is protected 2
• Suspensory cortical button technique exhibits maximum peak load to failure in biomechanical studies 3
• Suture anchor and interosseous screw techniques yield the least displacement 3

Postoperative Rehabilitation

Protected return of motion is critical for the first 8 weeks:

• Emphasize protected range of motion exercises initially 2
• Formal strengthening may begin at 8 weeks 2
• Return to unrestricted activities, including lifting, by 5 months 2

Common Pitfalls to Avoid

• Failing to distinguish between partial and complete tears through accurate MRI imaging, as this fundamentally changes treatment approach 1, 5, 6
• Relying solely on ultrasound for diagnosis, which has significantly lower accuracy than MRI 1, 5, 6
• Delaying surgical repair in active patients with complete distal tears, as chronic tears are more difficult to repair and may require augmentation 2
• Inadequate protection during early postoperative rehabilitation, which can compromise repair integrity 2

Patient Selection for Surgery

Surgical repair of distal biceps ruptures is indicated in:

• Healthy, active patients who want to restore supination strength and endurance 3, 4
• Patients with complete tears or partial tears >50% 8, 2
• Patients presenting acutely (within weeks of injury) for optimal outcomes 2