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Bicep Tendon Rupture

The biceps muscle is present on the front side of your upper arm and functions to help you bend and rotate your arm.

Biceps tendon tears at the shoulder: Two tendons that attach the biceps muscle to the bones in the shoulder, the long head tendon that attaches the muscle to the top of the shoulder’s socket (glenoid) and the short head that attaches it to the shoulder blade. Tears are more likely to occur in the long head of the biceps tendon. Tears of the short head of the biceps are very rare. But even in case of a complete tear of the long head, the short head of the biceps may allow you to continue using your biceps muscle. Overuse and injury leads to fraying of the biceps tendon and eventual rupture.

Biceps tendon tears at the elbow: Although two tendons attach the biceps muscle to the bone at the shoulder, only one tendon attaches it to the elbow. This is known as the distal biceps tendon. Tears of the distal biceps tendon are usually complete and the muscle is separated from the bone. Tears of the distal biceps tendon most often result from a sudden injury or lifting a heavy object.

A Biceps tendon rupture can either be partial, where it does not completely tear the tendon, or complete, where the biceps tendon completely splits in two and is torn away from the bone. 

Causes

Biceps tendon ruptures occur most commonly from an injury, such as a fall on an outstretched arm, or from overuse of the muscle, either due to age or from repetitive overhead movements such as with tennis and swimming.

Biceps tendon ruptures are common in people over 60 who have developed chronic micro tears from degenerative changes and overuse.   These micro tears weaken the tendon making it more susceptible to rupturing. 

Other causes can include frequent lifting of heavy objects while at work, weightlifting, long term use of corticosteroid medications and smoking.

Symptoms

The most common symptoms of a biceps tendon rupture include:

  • Sudden, sharp pain in the upper arm
  • Audible popping sound at the time of injury
  • Pain, tenderness and weakness at the shoulder or elbow
  • Trouble turning the arm palm up or down
  • Bulge above the elbow (Popeye sign)
  • Bruising to the upper arm

Diagnosis

Biceps tendon tear is usually diagnosed based on your symptoms, medical history, and physical examination. During the physical examination, your doctor will look for a gap in the front of the elbow. Your doctor will diagnose a partial tear by asking you to bend your arm and tighten the biceps muscle. You may have pain if there is a partial tear. X-rays may be taken to rule out other conditions causing shoulder and elbow pain. Using an MRI scan your doctor can know whether tear is partial or complete.

Treatment

Nonsurgical Treatment: Nonsurgical treatment is an option for patients whose injury is limited to the top of the biceps tendon.

Nonsurgical treatment includes:

Rest: A sling is used to rest the shoulder and you are advised to avoid overhead activities and heavy lifting until healed.

Ice: Applying ice packs for 20 minutes at a time, 3 to 4 times a day, helps reduce swelling.

Medications: Non-steroidal anti-inflammatory medicines help reduce pain and swelling.

Physical therapy: Strengthening and flexibility exercises help restore strength and mobility to the shoulder joint.

Surgical Treatment

Surgery may be necessary for patients whose symptoms are not relieved by conservative measures and for patients who require full restoration of strength, such as athletes.

Your surgeon makes an incision either near your elbow or shoulder, depending on which end of the tendon is torn. The torn end of the tendon is cleaned and the bone is prepared by creating drill holes. Sutures are woven through the holes and the tendon to secure it back to the bone and hold it in place. The incision is then closed and a dressing applied.

Risks and Complications

As with any surgery, complications can occur related to the anesthesia or the procedure. Most patients suffer no complications following biceps tendon repair, however, complications can occur and may include:

  • Infection
  • Nerve damage
  • Re-rupture of the tendon

Bicep Tendon Rupture - AAOS link