Tendon injury
Biceps tendon injury after a motor accident
A biceps injury may involve the long head at the shoulder, the distal tendon at the elbow, or a strain without rupture. The location matters because shoulder and elbow movement use different figures, and upper-limb strength testing is prohibited.
Motor accident injury
How can this injury happen?
Car or passenger collision
Forceful steering-wheel bracing or traction through the arm can strain or rupture a vulnerable biceps tendon.
Motorcycle accident
An outstretched-hand landing or sudden pull may injure the distal tendon near the elbow or the long head near the shoulder.
Pedestrian or cyclist impact
A direct blow or attempt to prevent a fall can load the elbow and shoulder against resistance.
Injuries that can occur
- long-head biceps strain, subluxation or rupture
- distal biceps partial or complete rupture
- associated rotator cuff, labral or elbow injury
- post-operative stiffness or nerve symptoms
Symptoms and functional problems
- bruising and a change in muscle contour
- pain with lifting, turning a key or using a screwdriver
- shoulder pain with long-head pathology
- elbow weakness and limited movement after repair
Seek urgent medical assessment
An acute suspected distal rupture should be assessed promptly because treatment timing may matter.
Clinical evidence
What findings matter?
The report should identify proximal or distal tendon involvement, whether rupture is partial or complete, and the residual movement or separate nerve impairment. A manual strength result is not an upper-limb WPI method.
| Record or examination | What it may establish | What it cannot prove alone |
|---|---|---|
| Ultrasound or MRI | Identifies tendon continuity, retraction and associated cuff or labral injury. | Imaging does not determine WPI or accident causation alone. |
| Shoulder and elbow examination | Records deformity, tendon tests and active movement in the affected joint. | Strength deficit cannot be rated through Table 34. |
| Operative report | Confirms tendon, fixation and complications. | Repair does not create a fixed percentage. |
Movement in daily life
How movement affects real activities
A proximal injury may affect shoulder elevation and rotation. A distal injury may affect elbow flexion and forearm rotation used for lifting, opening containers and tool work.
Shoulder elevation and rotation
Reaching overhead, dressing and positioning the arm for lifting.
Use the applicable shoulder Figures 36 to 44 when active restriction is permanent.
Elbow flexion and extension
Bringing objects to the mouth, pushing and straightening the arm.
Figures 30 to 32 address active elbow flexion and extension.
Pronation and supination
Turning keys, doorknobs, tools and the palm up to carry an object.
Figures 33 to 35 address active forearm rotation.
Threshold injury is a separate question: a medically verified partial or complete tendon rupture is excluded from the soft tissue definition. A strain or tendinopathy without rupture may be threshold.
Part 6 permanent impairment
How is CTP WPI assessed?
The residual joint movement is assessed through the applicable shoulder or elbow figures. Clause 6.57 allows analogy for an uncovered condition, but clause 6.67 prohibits upper-limb strength Table 34.
Measurement rules that apply
- Clause 6.50 requires active, not passive, range of motion for the impairment calculation. A goniometer should be used where clinically indicated, and unreliable movement should be repeated consistently before it is accepted.
- Clauses 6.51 and 6.52 permit a contralateral baseline only where the uninjured joint is a fair estimate of pre-accident mobility. The total upper-extremity impairment for each comparable joint is subtracted before conversion to WPI.
- Clause 6.67 prohibits upper-limb strength evaluation and AMA4 Table 34. A genuine peripheral nerve or muscle-bulk injury must use another permitted method without double counting.
| Method | CTP source | When it is relevant | Important limit |
|---|---|---|---|
| Shoulder ROM | Figures 36-44; clause 6.50 | Proximal tendon injury with permanent shoulder restriction. | Do not convert weakness into an angle. |
| Elbow/forearm ROM | Figures 30-35; clause 6.50 | Distal injury with permanent elbow or forearm restriction. | Rate the affected motions without duplication. |
| Analogy | Clauses 6.24 and 6.57 | An objectively established residual not represented by ROM. | Exact source criteria must be verified before assigning a value. |
- Identify the tendon level before choosing shoulder or elbow method.
- Assess the post-treatment stable condition.
- Do not use grip, elbow-flexion or supination strength as Table 34 impairment.
What cannot be combined?
- shoulder and elbow values unless separate permanent impairments are established
- ROM and analogy for the same tendon consequence
- prohibited strength rating
What does not establish WPI by itself?
- Popeye appearance alone
- MRI rupture alone
- manual weakness alone
- surgical repair
Motor accident examples
Distal rupture repaired after a motorcycle fall
The repair confirms injury but permanent active elbow and forearm movement, or another verified method, determines impairment.
Long-head rupture with preserved movement
A visible contour change may not produce an assessable musculoskeletal WPI if active function is preserved.
Claim file preparation
Evidence checklist
Assessment source
Biceps tendon WPI source
Assessment source: Motor Accident Guidelines v10.1 clauses 6.24, 6.47-6.57 and 6.67; AMA4 elbow Figures 30-35, shoulder Figures 36-44 and Table 3.
Threshold injury: Verified partial or complete tendon rupture may be non-threshold; strain or tendinopathy without rupture may be threshold.
What the assessor checks
- joint-specific ROM
- analogy rule
- Table 3 conversion
- strength prohibition
What does not establish the result by itself
- appearance
- scan
- weakness
- repair
Official sources
Related NSW CTP guides
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Frequently asked questions
- Does a biceps rupture have fixed WPI?
- No. The assessor must apply a permitted method to permanent residual impairment.
- Can loss of lifting strength be rated?
- Not under upper-limb Table 34, which clause 6.67 prohibits.
- Which joint is assessed?
- Proximal tendon problems may affect shoulder methods; distal injuries may affect elbow and forearm methods.
- Does surgery prove permanent impairment?
- No. It proves treatment and findings, but the stable post-treatment result controls WPI.
- Is a biceps tear threshold?
- A verified partial or complete tendon rupture is excluded from soft tissue injury; a strain without rupture may be threshold.