LHB Tendon Rupture
The biceps may rupture at the top of the bicipital groove in the shoulder (long head of biceps - LHB) or at the biceps tuberosity in the elbow. Click here for bicep ruptures at the elbow.
The Long Head of Biceps (LHB) tendon is an important tendon for walking in four-legged animals, but in humans it has very little function or strength. It may have a small role in shoulder stability when all the other tendons are gone, but it does not contribute any strength to the biceps muscle itself.
It is a common cause of pain with shoulder injuries and diseases as it has a lot of nerve cells. It can degenetate and inflame (tendonitis). A diseased LHB can also rupture.
There is often a relief of chronic shoulder pain when the tendon ruptures, since the partially torn tendon is often the main cause of pain (see biceps tendonitis). This rupture is equivalent to a natural tenotomy. When the bicep injury occurs, pain is instant and you might hear a "pop" sound. Bicep injury bruising will follow soon after. This results in a 'popeye' deformity and weakness of the biceps.
Surgery is very rarely needed for a LHB tendon rupture, as most people and function perfectly well, without any loss of strength or pain. A bulging 'popeye' bicep might be visible in leaner people, but does not cause any functional loss.
Very rarely a small proportion of people may have long-term issues and then a biceps tenodesis is an option - but this is not to improve the appearance or cosmesis.
Ruptured right LHB with Popeye sign biceps (arrow)