What Are Biceps and Triceps Tears?
The biceps and triceps are the primary muscles governing elbow flexion and extension. Each muscle is anchored to bone at both ends by tendons, and tears can occur at either attachment point — proximally at the shoulder or distally at the elbow.
Proximal biceps tears occur at the top of the shoulder, where the long head of the biceps originates from the superior labrum of the glenoid. This tendon runs through the shoulder joint and is vulnerable to fraying and rupture, particularly in middle-aged and older adults. A proximal long-head tear often produces the classic "Popeye" deformity — a visible ball of muscle that descends toward the elbow.
Distal biceps tears occur at the elbow where the biceps tendon inserts on the radial tuberosity. This is a higher-stakes injury because the entire biceps muscle loses its distal attachment, causing significant loss of flexion and forearm rotation strength.
Triceps tears are less common and occur at the back of the elbow where the triceps tendon attaches to the olecranon. They are typically caused by a fall onto an outstretched arm or a direct blow and result in weakness or complete inability to extend the elbow against resistance.
Dr. Jay Levin at Duke Health in Durham, NC, evaluates and treats the full spectrum of biceps and triceps tendon injuries, serving patients from Cary, Raleigh, and across North Carolina.
Causes
The most common mechanism for both biceps and triceps tears is an eccentric overload — the muscle contracts forcefully while being stretched in the opposite direction. Typical scenarios include:
- Catching a heavy falling object
- Lifting an unexpectedly heavy load
- A fall onto an outstretched arm
- A sudden block or missed step during athletic activity
Risk factors include:
- Age-related tendon degeneration (tears are most common in men aged 40–60)
- Heavy manual labor or weight training
- Prior corticosteroid injections near the tendon, which can weaken tendon fibers
- Anabolic steroid use, which increases muscle bulk relative to tendon capacity
- Fluoroquinolone antibiotic exposure, which is associated with increased tendon fragility
When to See a Specialist
Seek immediate or urgent evaluation if you experience:
- A sudden "pop" at the shoulder or elbow during exertion, followed by immediate pain
- Visible swelling, bruising, or deformity of the upper arm or elbow crease
- Weakness or inability to lift the forearm or extend the elbow
- A palpable gap where the tendon should be
Time matters for distal injuries. The tendon retracts after rupture, and repair becomes significantly more difficult after 3–4 weeks due to muscle shortening and scar tissue formation. Proximal long-head tears at the shoulder are less time-sensitive but should still be evaluated to rule out associated rotator cuff pathology.
Treatment Options at Duke Health
Dr. Jay Levin provides comprehensive tendon repair at Duke Health in Durham, NC, tailoring the approach to the location and severity of the tear, the patient's age, activity level, and functional demands.
Nonsurgical treatment may be appropriate for:
- Proximal long-head biceps tears in older, less active patients, where the functional deficit is modest and physical therapy can compensate
- Partial tears that do not significantly impair function
- Patients with medical conditions that make surgery inadvisable
Surgical treatment is recommended for most distal biceps tears in active individuals and for triceps tears with significant functional loss. Dr. Levin performs:
- Distal biceps repair — The retracted tendon is retrieved and reattached to the radial tuberosity using suture anchors or a cortical button fixation technique, restoring the full mechanical advantage of the biceps at the elbow.
- Proximal biceps tenodesis or tenotomy — For painful long-head biceps tears at the shoulder, the tendon is either released (tenotomy) or reanchored to the humerus (tenodesis) to eliminate the pain associated with the torn tendon and prevent deformity.
- Triceps repair — The avulsed triceps tendon is reattached to the olecranon with sutures and anchors, allowing full restoration of elbow extension strength with appropriate rehabilitation.
- Reconstruction for chronic tears — When repair is delayed and the tendon is significantly retracted or degenerated, Dr. Levin may use graft tissue to bridge the defect and restore function.
A structured physical therapy program follows all surgical repairs, with progressive milestones guiding return to lifting and sport.