Biceps Tendon Tear
What is a biceps tendon tear?
The biceps is the muscle in the front of the upper arm. You use it when you rotate your forearm and bend your elbow. Biceps tendons attach the biceps muscle to bones in the shoulder and the elbow. The tendons that connect the biceps muscle to the shoulder joint are called the proximal biceps tendons. The tendon that attaches the biceps muscle to the forearm bones is called the distal biceps tendon. A biceps tear can occur in either location.
Partial biceps tears do not completely sever the tendon. Complete tears (also called biceps rupture) mean the tendon has torn away from the bone.
How does a biceps tear occur?
Injury and overuse are the most common causes of a biceps tear. Risk increases with age, excessive shoulder use, overtraining, heavy lifting, falling onto an outstretched arm. Most tears occur in patients in their fifth and sixth decades of life.
A complete tear of the long head
at its attachment point in the glenoid.
What are the symptoms of a biceps tear?
Common symptoms of a biceps tear include:
- Sudden, severe pain at the shoulder or the elbow
- An audible pop or snap when the injury occurs
- Bruising on the upper arm
- Tenderness in the shoulder or elbow
- Weakness in the shoulder or elbow
- Difficulty rotating the arm from a palm down to a palm up position
- A bulge in the upper arm above the elbow (known as "Popeye muscle")
A distal biceps tendon tear can cause
the muscle to ball up near the shoulder.
Bruising at the elbow is also common.
How is a biceps tear diagnosed?
In addition to a physical exam and patient history, your doctor can use specific tests, including MRI especially if a partial tear is suspected to diagnose a biceps tear and rule out other problems. Long head biceps tears at the shoulder are often associated with full thickness rotator cuff tears and MRI is helpful in ruling out a rotator cuff tear that may change treatment plan.
A biceps tendon tear is made more obvious
by contracting the muscle ("Popeye Muscle").
What is the treatment?
Many biceps tears at the shoulder do not require surgery. For many people with partial tears, pain may resolve over time. Nonsurgical treatment, including ice, rest and non-steroidal anti-inflammatory medications may help relieve pain and swelling. Physical therapy can help restore strength.
If these conservative methods fail to alleviate symptoms, surgery may be necessary. In addition, athletes, manual laborers and others who want to regain full arm strength may opt for surgery.
Surgical treatment depends on the nature and extent of the damage. Partial tears may only require a simple arthroscopic shaving (called a debridement) of the torn fibers. If the tear is more severe, surgery is performed to re-anchor the torn tendon back to the bone or simply cut the tendon (tenotomy) in older sedentary patients.
Many biceps repairs are performed arthroscopically. In this minimally invasive approach, the surgeon makes several small incisions around the injury site and inserts a narrow fiber optic scope (called an arthroscope) to examine the condition of the tendon. Tiny instruments are used to remove the frayed edges, if the tear is small, or repair and reattach the tendon, if the tear is more severe. Patients experience less pain and blood loss, fewer complications and a faster recovery. As with all surgical procedures, specific recovery time varies by patient and demand.
Ultimately, the type of procedure performed depends on the severity of your symptoms, as well as your overall health and other factors. It is important to consult with a qualified surgeon who is trained in these techniques to determine the best course of action.
For complete biceps tendon tears at the elbow, surgery is typically recommended especially in younger patients, laborers, carpenters and mechanics. Complete biceps tears at the elbow results in significant loss of supination (turning palm face up) power with the elbow bent ninety degrees. Surgical repair results in superior functional outcomes compared to non-operative treatment. Surgical repair is optimal in the first 3 weeks after injury. Delay beyond three weeks often requires grafting to accomplish re-attachment of the biceps tendon back to the bone in the elbow.
X-rays showing metal implants called suture anchors
that have been used to secure the biceps tendon to the bone.