Long Head of Biceps Rupture

Upper Limb

Overview

Long head of biceps (LHB) rupture is a complete or partial tear of the proximal tendon of the biceps brachii muscle, typically occurring at the bicipital groove. It commonly results from acute trauma superimposed on chronic tendinopathy, rotator cuff pathology, or degenerative changes. While functionally limiting, isolated LHB rupture often resolves well with conservative management and physiotherapy.

Pathophysiology

The long head of biceps originates at the supraglenoid tubercle and passes through the bicipital groove of the humerus, where it is subject to friction and mechanical stress. A tendon already weakened by degeneration usually ruptures during sudden eccentric loading or forceful elbow flexion. Complete rupture results in retraction of the muscle belly, loss of active flexion and supination strength, and characteristic cosmetic deformity ('Popeye' muscle sign).

Patient Education

A biceps rupture typically does not require surgical repair for functional recovery; most patients regain satisfactory strength and function with conservative management, though some permanent weakness and cosmetic deformity may persist.

Typical Presentation

Site

Anterior shoulder and upper arm, pain localized to the bicipital groove and upper arm

Quality

Acute sharp pain followed by aching discomfort; sharp tearing sensation at moment of injury

Intensity

Severe acute pain (8-9/10) at onset, reducing to mild-moderate (3-5/10) within days; intensity varies with activity

Aggravating

Resisted elbow flexion, resisted supination, heavy lifting, forceful gripping, repetitive overhead activities

Relieving

Rest, ice application, anti-inflammatory medications, arm support/sling, gentle passive movement

Associated

Immediate bruising and swelling in upper arm, visible muscle bulging ('Popeye' sign) with complete rupture, weakness of elbow flexion and supination, palpable defect in bicipital groove, shoulder pain if concurrent rotator cuff pathology

Orthopaedic Tests

Test descriptions are written with AI assistance from standard clinical texts. Where a test lists Sources, its description has been checked against them; those sources are independent and do not endorse OsteoKit. Accuracy figures and grades (A–D) appear only when checked against the published study; tests without one are marked “No accuracy study”.

Further reading: full test procedures are described in standard clinical examination texts, e.g. Magee & Manske, Orthopedic Physical Assessment (7th ed.), and Cook & Hegedus, Orthopedic Physical Examination Tests: An Evidence-Based Approach (2nd ed.).

No accuracy study

Speed's Test

Procedure

Patient standing, shoulder flexed to 90°, elbow straight, forearm supinated. Apply a downward force at the forearm while the patient resists.

Positive Finding

Pain in the bicipital groove.

Interpretation

Tests an irritable biceps tendon rather than a ruptured one. After a complete rupture, pain may settle and the test can be negative. It adds little to the diagnosis of rupture. Speed's test accuracy is inconsistent across studies (e.g. Bennett 1998: 90% sensitivity, 14% specificity); no reliable pair is shown.

Sources

No accuracy study

Popeye Sign (Clinical Deformity Assessment)

Procedure

Compare both arms with the elbows bent to 90° and the biceps contracted against resistance. Look and feel for a bulge in the lower arm.

Positive Finding

The biceps belly is bunched lower down the arm than on the other side (a 'Popeye' bulge), often after a sudden pop and bruising.

Interpretation

A clear Popeye deformity after a pop strongly supports rupture of the long head of biceps, and many cases need no imaging. It can be hard to see in people with more body fat, and a partial tear causes no deformity. Deformity near the elbow crease suggests a distal biceps rupture instead, which needs urgent orthopaedic referral. The Popeye sign is a visible/palpable deformity; no validated sensitivity/specificity exists and the previously cited figures (attributed to Hegedus 2012) are not in that paper.

Sources

No accuracy study

Yergason's Test

Procedure

Patient seated, arm at the side, elbow bent to 90°, forearm pronated. Ask the patient to turn the palm up and bend the elbow against your resistance.

Positive Finding

Pain in the bicipital groove.

Interpretation

Assesses an irritable biceps tendon rather than a rupture. After a complete rupture it may be painless. Check supination strength, which is usually only mildly reduced after a long-head rupture.

Sources

Further reading

No accuracy study

Biceps Load Test II (Forearm Supination Test)

Procedure

Patient supine. Shoulder abducted to 120° and fully externally rotated, elbow bent to 90°, forearm supinated. Ask the patient to bend the elbow against your resistance.

Positive Finding

Deep pain in the shoulder during resisted elbow flexion.

Interpretation

Designed for SLAP lesions (biceps anchor), not for a ruptured long head. It may help find an associated superior labral problem. The Biceps Load Test II (Kim 2001) is validated for SLAP lesions, not long-head biceps rupture; its figures do not transfer to this condition and are shown as Not verified here.

Sources

No accuracy study

Passive External Rotation Range

Procedure

Patient supine. Take the shoulder into abduction and external rotation, and compare the range and end-feel with the other side.

Positive Finding

Reduced range or pain compared with the other side.

Interpretation

A range-of-motion check for associated shoulder problems; it does not diagnose a biceps rupture. The crank test is a separate labral test; the name has been corrected.

Sources

No accuracy study

Upper Limb Neurodynamic Test (ULNT)

Procedure

Patient supine. With the shoulder girdle held down, abduct and externally rotate the shoulder, supinate the forearm, extend the wrist and fingers and then the elbow. Add neck side-flexion away from and towards the test side.

Positive Finding

Reproduction of the familiar arm symptoms that changes with neck side-flexion.

Interpretation

Helps tell nerve-related arm pain from a muscle or tendon injury. There is no 'biceps bias' version of this test.

Sources

⚠ Red Flags

  • •Severe uncontrolled pain or swelling suggesting compartment syndrome
  • •Signs of neurovascular compromise (numbness, tingling, colour changes, coolness distally)
  • •History of significant trauma with polytrauma or fracture
  • •Inability to move arm following injury suggesting associated brachial plexus injury
  • •Systemic symptoms (fever, night sweats, weight loss) suggesting infection or malignancy

⚡ Yellow Flags

  • •Work-related or compensable injury affecting motivation for rehabilitation
  • •Catastrophic thinking about loss of strength or function
  • •Fear-avoidance behaviour limiting early mobilization
  • •Unrealistic expectations regarding cosmetic outcome or timeline for recovery
  • •Psychological distress related to visible muscle deformity ('Popeye' sign)

Osteopathic Techniques

Most long head of biceps ruptures are managed without surgery, though a bulge and some cramping can remain. Younger or athletic patients who mind the deformity, and those with rotator cuff problems, may be referred for a surgical opinion. No trials of manual techniques were found.

Safety: Muscle energy techniques are not used on a ruptured tendon or muscle.

Region

Rotator cuff, deltoid and periscapular muscles

Technique

Soft tissue, shoulder and periscapular musclesNo trials found

Rationale

Eases tension in the muscles around the shoulder. No trials after biceps rupture.

How it's done & evidence

How it's done

Hands-on kneading, stroking and sustained pressure to the muscles around the shoulder: the rotator cuff, deltoid and the muscles around the shoulder blade. In trials it was given alongside shoulder exercise.

Evidence in Long Head of Biceps Rupture

Searched 24 Oct 2026: no trials of shoulder soft tissue technique in biceps rupture.

Region

Upper and mid thoracic spine

Technique

Articulation, thoracicNo trials found

Rationale

Gentle upper-back mobilisation. No trials after biceps rupture.

How it's done & evidence

How it's done

Rhythmic, low-velocity movement of restricted thoracic segments within their passive range, with no thrust. The patient is seated, side-lying or prone. For neck problems the upper thoracic segments (T1–T6) are the usual focus.

Evidence in Long Head of Biceps Rupture

Searched 24 Oct 2026: no trials of thoracic mobilisation in biceps rupture.

Sources

Rehabilitation Exercises

Pendulum Shoulder Circles

Range of MotionBeginner

Supine Shoulder Flexion with Towel Slide

Range of MotionBeginner

Pectoralis Major Doorway Stretch

StretchingBeginner

Cross-Body Shoulder Stretch

StretchingBeginner

Isometric Elbow Flexion (Neutral Position)

StrengtheningBeginner

Supine Active-Assisted Elbow Flexion

StrengtheningBeginner

Supine Elbow Flexion with Wrist Supination (Light Resistance Band)

StrengtheningIntermediate

Seated Biceps Curl with Dumbbell (Progressive Weight)

StrengtheningIntermediate

Scapular Retraction in Standing

PosturalBeginner

Single-Arm Stability Ball Support Hold

BalanceIntermediate

Prone Row with Unilateral Arm (Opposite Side to Injury)

StrengtheningAdvanced

Walking or Stationary Cycling with Progressive Intensity

CardiovascularBeginner

Referral Criteria

  • •Severe uncontrolled pain unresponsive to conservative management beyond 2-3 weeks
  • •Neurovascular compromise or signs of brachial plexus injury
  • •Suspected compartment syndrome with severe swelling and pain
  • •Young athletic patient or overhead athlete seeking surgical repair for functional return to sport
  • •Associated full-thickness rotator cuff tear or glenohumeral instability requiring imaging and specialist assessment
  • •No functional improvement in strength or pain after 6-8 weeks of conservative management
  • •Imaging findings revealing additional pathology (fracture, dislocation, or extensive soft tissue damage)