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Tear of the Long Tendon of the Biceps

Tears of the long tendon of the biceps muscle are seen in gymnasts, tennis players and badminton players, wrestlers, rowers, weightlifters, and javelin throwers.

The long biceps tendon is susceptible to degenerative changes, which predispose it to rupture. The tears occur most often in athletes over the age of 40–50 years; in younger athletes this injury is relatively unusual. The injury mechanism is a sudden eccentric (opposite-directed) resistance during flexion and/or external rotation of the elbow or shoulder.

Symptoms and diagnosis

– Moderate pain occurs over the anterior aspect of the shoulder joint.
– Swelling is visible over the anterior aspect of the upper arm.
– There is inability to contract the muscle against resistance in the acute stage.
– Strength is moderately impaired when the elbow joint is flexed and the forearm is supinated.
– Slow contraction of the biceps produces a more prominent swelling than that produced by the normal biceps of the healthy arm. The muscle fails to make its full contribution to flexing of the elbow joint.


The athlete should consult a doctor for advice.

The doctor may:
– prescribe physiotherapy and mobility exercises;
– operate when a complete rupture has affected a young athlete active in overhead sports.


If surgery is not considered necessary, mobility and strength exercises can be started as soon as the pain begins to subside. After conservative treatment there may be some residual weakness.

If surgery is carried out, range-of-motion exercises start within 1–2 weeks. Conditioning exercises not involving the upper extremity can start early. Gradually increased strength training should not be resumed
until a few weeks later. Contact sports should be avoided for 2–3 months.

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