What is the recommended treatment for a patient with a tear of the short head of the biceps?

Treatment of Short Head Biceps Tear

For acute traumatic short head biceps tears in active patients, surgical repair is recommended to restore biceps function and enable return to sport, while conservative management may be considered for older, less active individuals. 1, 2

Initial Diagnostic Confirmation

Before treatment decisions, confirm the diagnosis with appropriate imaging:

• Obtain plain radiographs first to exclude associated fractures or bony abnormalities 3, 4
• MRI without contrast is the gold standard for confirming the tear, with 86.4% accuracy compared to 45.5% for ultrasound 3, 4
• Use the FABS view (flexion-abduction-supination) on MRI for optimal visualization of the biceps tendon 3, 4
• Distinguish between partial and complete tears, as this critically impacts treatment decisions 3, 1

Clinical Presentation Specific to Short Head Tears

Short head biceps tears present with unique findings that differentiate them from common biceps pathology:

• "Reverse Popeye" deformity may be visible 1
• Palpable tendon remains in the antecubital fossa (unlike complete distal biceps ruptures) 1
• Pain and weakness with resisted forearm supination and elbow flexion 1
• History of forceful flexion against eccentric load is the typical mechanism 1

Treatment Algorithm

For Active, Young Patients (Recommended Approach)

Surgical repair is the treatment of choice for acute traumatic short head biceps ruptures in active individuals:

• Anatomic repair of the short head component achieves better clinical outcomes when performed early 1, 2
• Arthroscopic repair technique involves reinsertion of the short head into the coracoid process using an anchor with nonabsorbable double suture 2
• Expected recovery timeline: active range of motion at 8 weeks, full return to sport at 16 weeks 2
• All three patients in the case series successfully returned to baseline activity after anatomic repair 1

For Older, Less Active Patients

Conservative management is an option for this population:

• Relative rest to decrease repetitive loading 4
• Oral NSAIDs for pain management 4
• One case report documented successful conservative treatment of a complete biceps tear, though this was not specifically isolated to the short head 5

Critical Pitfalls to Avoid

• Misdiagnosing as a partial or complete common distal biceps tear rather than recognizing the selective short head disruption 1
• Failing to perform meticulous physical examination to identify the reverse Popeye deformity and palpable tendon 1
• Inadequate review of MRI studies missing the classic findings of this rare injury pattern 1
• Delaying surgical treatment in active patients, as early repair achieves superior outcomes 1, 2

Surgical Considerations

When surgery is indicated:

• Evaluate the long head component intraoperatively for partial tearing that may require independent repair 1
• Arthroscopic technique is minimally invasive with good functional results and satisfactory return to sport 2
• Open repair through the muscle belly has been successfully performed in the rare cases of muscle belly rupture rather than tendon rupture 6

Evidence Quality Note

Short head biceps tears are exceptionally rare injuries with limited high-quality evidence. The treatment recommendations are based primarily on case reports and small case series 1, 2, 6. Maintain a high index of suspicion for this unusual injury pattern, as it can be easily misdiagnosed and mistreated 1.