Short Head Biceps Tears Are Extremely Rare Compared to Long Head Tears
Yes, short head biceps tears are significantly rarer than long head biceps tendon tears, with proximal (long head) tears being the most common biceps injury pattern overall. 1
Epidemiology and Injury Patterns
The long head of the biceps is far more susceptible to injury than the short head:
Partial rupture of the long head with an intact short head represents the most common biceps injury pattern, while isolated complete ruptures of the long head are the least common injury pattern. 2
Traumatic ruptures have a significantly higher association with short head involvement, whereas atraumatic ruptures involve the long head in 89% of cases. 2
Rupture of the short head component is explicitly described as a "rare injury" that may be difficult to diagnose and treat. 3
The prevalence of partial long head biceps tears is approximately 5% of all arthroscopic shoulder procedures, and these are commonly associated with rotator cuff tears (85% of cases). 4
Anatomical Considerations Explaining the Rarity
The short head's relative protection from injury relates to its unique anatomy:
The short head consists of muscle fibers attaching directly to the coracoid process with only a thin tendinous aponeurosis covering its anterior surface, rather than a true tendon. 5
This muscular origin provides inherent protection compared to the long head's true tendinous structure, which is exposed to greater mechanical stress within the glenohumeral joint and bicipital groove. 5
Clinical Recognition of Short Head Tears
When short head tears do occur, they present with distinctive features:
The mechanism is typically forceful flexion against an eccentric load. 3
Physical examination reveals a palpable tendon in the antecubital fossa (the intact long head), a "reverse Popeye" deformity, and pain/weakness with resisted supination and flexion. 3
Meticulous physical examination and careful MRI review are required to differentiate this rare injury from partial or complete tears of the common distal biceps tendon. 3
Clinicians should maintain a high index of suspicion, as this injury can be easily misdiagnosed and mistreated. 3
Diagnostic Approach
When evaluating suspected biceps pathology:
MRI without contrast is the preferred imaging modality with 86.4% accuracy for biceps tendon tears. 6, 1, 7
The FABS (flexion-abduction-supination) view optimizes visualization of the distal biceps tendon. 6, 1, 7
Plain radiographs should precede advanced imaging to exclude fractures or bony abnormalities. 6, 1, 7