Dr Puah Ken Lee 潘健理
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Practising at Mount Elizabeth Novena Hospital, Singapore
Appointments by prior arrangement
Dr Puah Ken Lee 潘健理
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Mount Elizabeth Novena Hospital, Singapore
✔ Subspecialty Focus in Shoulder & Elbow, Sports Injuries
✔ Practising at Mount Elizabeth Novena Hospital
✔ Evidence-based treatment, Individualised Care
Proximal Biceps Tendon Tear
A proximal biceps tendon tear is an injury to one of the tendons that attaches the biceps muscle to the shoulder. The long head of the biceps tendon is most commonly affected and may partially or completely tear.
Unlike a distal biceps tendon tear, which occurs near the elbow, a proximal tear occurs at the shoulder and is often associated with rotator cuff disease, shoulder impingement or shoulder labral injuries.
Many proximal biceps tendon tears can be managed successfully without surgery. When surgery is recommended, the most appropriate procedure depends on your symptoms, activity level and any associated shoulder conditions.
Looking for an injury near the elbow?
Read our page on Distal Biceps Tendon Tear, which is a different condition requiring different treatment.
What is the Biceps Tendon?
The biceps muscle has two tendons that attach it to the shoulder:
- Long head of the biceps tendon
- Short head of the biceps tendon
The long head travels through the shoulder joint before attaching to the superior labrum, making it vulnerable to injury.
Most proximal biceps tendon tears involve the long head.
What Causes a Proximal Biceps Tendon Tear?
The tendon may tear gradually over time or following an injury.
Common causes include:
- Age-related degeneration
- Rotator cuff tears
- Shoulder impingement
- Heavy lifting
- Sudden force applied to the arm
- Falls
- Sports injuries
- Repetitive overhead activities
Because the long head of the biceps tendon shares a close relationship with the rotator cuff, these injuries commonly occur together.
Symptoms
Patients may notice:
- Sudden pain in the front of the shoulder
- A popping sensation
- Bruising down the upper arm
- A bulge in the upper arm (“Popeye” deformity)
- Shoulder weakness
- Cramping
- Difficulty lifting overhead
- Pain when carrying heavy objects
Some patients experience surprisingly little pain after the tendon ruptures because the damaged tendon is no longer under tension.
Types of Proximal Biceps Tendon Injuries
Partial Tear
Only part of the tendon is damaged.
Symptoms often include persistent pain without a visible deformity.
Complete Tear
The tendon separates completely from its attachment.
Patients may notice:
- A sudden “pop”
- Bruising
- A Popeye deformity
- Mild weakness, particularly with elbow flexion and forearm supination
- Reduced endurance during repetitive activities
Many patients continue to function well despite a complete rupture of the long head of the biceps tendon.
| Feature | Partial Tear | Complete Long Head Tear |
|---|---|---|
| Onset | Often gradual | Often sudden |
| Pain | Usually persistent | Often severe initially, then improves |
| “Pop” sensation | Uncommon | Common |
| Popeye deformity | Usually absent | May be present |
| Bruising | Uncommon | May occur |
| Shoulder strength | Usually preserved but painful | Mild loss of strength/endurance |
| Common treatment | Physiotherapy; surgery if symptoms persist | Usually non-surgical unless persistent symptoms or associated injuries |
Associated Shoulder Conditions
A proximal biceps tendon tear frequently occurs alongside other shoulder problems, including:
- Rotator cuff tear
- SLAP tear
- Shoulder impingement
- Shoulder arthritis
- Shoulder labral tear
Treatment is directed at the overall shoulder problem rather than the tendon alone.
How is a Proximal Biceps Tendon Tear Diagnosed?
Diagnosis begins with a clinical assessment.
Your orthopaedic surgeon will evaluate:
- How the injury occurred
- Location of pain
- Shoulder movement
- Muscle strength
- Presence of a Popeye deformity
- Associated rotator cuff weakness
Imaging
Ultrasound
Ultrasound can identify:
- Complete tendon rupture
- Partial tears
- Tendon inflammation
- Biceps instability
It also allows dynamic assessment of the tendon during shoulder movement.
MRI
MRI is useful for identifying:
- Rotator cuff tears
- Labral tears
- Partial biceps tears
- Tendon degeneration
- Associated cartilage injuries
MRI is often recommended when surgery is being considered or when associated shoulder injuries are suspected.
Non-Surgical Treatment
Most isolated long head biceps tendon ruptures can be managed without surgery.
Treatment may include:
- Activity modification
- Physiotherapy
- Anti-inflammatory medication
- Progressive strengthening
- Ultrasound-guided injections in selected cases
Many patients regain excellent shoulder function and return to normal daily activities.
When is Surgery Recommended?
Surgery may be considered when:
- Pain persists despite rehabilitation
- A significant associated rotator cuff tear is present
- Cosmetic appearance is an important concern
- Cramping limits function
- High-demand manual work or sport requires greater endurance
- A partial tear continues to cause symptoms
The decision is individualised based on your symptoms and functional goals.
Surgical Treatment
When surgery is appropriate, options may include:
Biceps Tenodesis
The damaged long head of the biceps tendon is reattached outside the shoulder joint.
This procedure is commonly recommended for:
- Active patients
- Younger individuals
- Patients undergoing rotator cuff repair
- Persistent biceps pain
Biceps Tenotomy
The damaged tendon is released without reattachment.
This may be appropriate for:
- Older patients
- Lower-demand individuals
- Patients in whom rapid pain relief is the primary goal
The choice between tenodesis and tenotomy depends on your age, activity level, cosmetic concerns and associated shoulder pathology.
Recovery
Recovery depends on whether surgery is required and whether other shoulder procedures are performed at the same time.
Typical recovery includes:
| Activity | Approximate Time |
|---|---|
| Sling | 2–6 weeks |
| Office work | 1–2 weeks |
| Driving | 2–6 weeks |
| Physiotherapy | Begins early |
| Strengthening | 8–12 weeks |
| Return to sports | 3–6 months |
Frequently Asked Questions
Is a proximal biceps tendon tear the same as a distal biceps tendon tear?
No.
A proximal biceps tendon tear occurs at the shoulder and often does not require surgery.
A distal biceps tendon tear occurs near the elbow and frequently requires early surgical repair to restore strength.
What is a Popeye deformity?
A Popeye deformity is a bulge in the upper arm caused by the long head of the biceps tendon retracting after a complete rupture.
Although the appearance may be noticeable, many patients continue to have good shoulder function.
Will I lose strength?
Most patients experience only a modest reduction in strength after an isolated long head rupture. Many return to everyday activities without significant limitations, particularly after rehabilitation.
Will I need surgery?
Not necessarily. Many proximal biceps tendon tears respond well to non-surgical treatment. Surgery is usually reserved for persistent pain, functional limitations or associated shoulder conditions.
Why Choose Dr Puah Ken Lee?
Dr Puah Ken Lee is an orthopaedic surgeon in Singapore whose practice focuses on shoulder, elbow and sports injuries. He has extensive experience treating proximal biceps tendon disorders, rotator cuff disease and shoulder instability. Treatment is tailored to each patient’s symptoms, examination findings and lifestyle, with surgery recommended only when it is likely to improve pain and function.
Related Conditions
- Rotator Cuff Tear
- Shoulder Labral Tear
- SLAP Tear
- Shoulder Impingement
- Shoulder Pain
- Shoulder Instability
- Shoulder Arthritis
- Shoulder Surgery
- Sports Injuries
- First Orthopaedic Consultation
- Return to Sport After Injury
For a full overview of shoulder conditions, visit Shoulder Specialist Singapore
Dr Puah is regularly invited to teach shoulder surgery internationally
Specialist Care for Shoulder Injuries in Singapore
Dr Puah is an orthopaedic surgeon specialising in shoulder, elbow and sports injuries. He provides personalised care tailored to each patient’s condition and activity level.
Consultations are available at Mount Elizabeth Novena.
If you are experiencing shoulder pain that is affecting your daily life or sports, early assessment can help guide appropriate treatment.
Book a consultation or contact the clinic to discuss your condition.
Book a Consultation
Book a consultation or contact the clinic via WhatsApp to get started
Book a consultation at 360 Orthopaedics, Mount Elizabeth Novena
Proximal biceps tears are common and are treatable. Early diagnosis and appropriate management can improve outcomes and prevent long-term problems.
Dr Puah Ken Lee is an orthopaedic surgeon in Singapore specialising in shoulder, elbow and sports injuries at 360 Orthopaedics, Mount Elizabeth Novena. Patients with persistent shoulder pain or instability are encouraged to seek specialist evaluation.