BICEPS TENDON TEARS

Anatomy of the biceps tendon

There are two attachments of the biceps tendon at the shoulder joint.

A complete tear of the long head of the biceps at its attachment point in the glenoid.

What is a biceps tendon tear?

If you tear the biceps tendon at the shoulder, you may lose some strength in your arm and be unable to forcefully turn your arm from palm down to palm up (supination). Many people who have torn their biceps can still function, and only need simple treatments to relieve symptoms. Some people require surgery to repair the torn tendon. Biceps tendon tears can be either partial or complete.

Symptoms

• Sudden, sharp pain in the upper arm


• Sometimes an audible pop or snap


• Bruising from the middle of the upper arm down toward the elbow


• Pain or tenderness at the shoulder and the elbow


• Weakness in the shoulder and the elbow


• Difficulty turning the arm palm up or palm down


• Cramping of the biceps muscle with strenuous use of the arm


• Because a torn tendon can no longer keep the biceps muscle tight, a bulge in the upper arm above the elbow ("Popeye Muscle") may appear.

Types of biceps tendon tears

• Partial tears: Many biceps tears do not completely sever the tendon.


• Complete tears: A complete biceps tear will split the tendon into two pieces

In many cases, torn biceps tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object. Fortunately, the biceps have two attachments at the shoulder. The short head of the biceps rarely tear, and many people can still use their biceps even after a complete tear of the long head. When you tear your biceps tendon, you can also damage other parts of your shoulder (rotator cuff and labrum).

Causes of biceps tendon tears

• Injury: If you fall hard on an outstretched arm or lift something too heavy, you can tear your biceps tendon.


• Overuse: Many biceps tears are the result of a wearing down and fraying of the tendon that occurs slowly over time. This naturally occurs as we age. It can be worsened by overuse or repetitive movements. Overuse can cause a range of shoulder problems (tendonitis, shoulder impingement, and rotator cuff injuries).

Risk Factors

Risk for a tendon tear in the biceps increases with:

1. Age: Older people have put more years of wear and tear on their tendons than younger people.


2. Shoulder overuse: Repetitive overhead sports - such as swimming or tennis - can cause more tendon wear and tear.


3. Heavy overhead activities: Too much load during weightlifting is a prime example of this risk, but many jobs require heavy overhead lifting and put excess wear and tear on the tendons.


4. Corticosteroid medications. Using corticosteroids has been linked to increased muscle and tendon weakness.


5. Smoking. Nicotine use can affect nutrition and blood supply in the tendon.

How are biceps tendon tears diagnosed?

After discussing your symptoms and medical history, your doctor will examine your shoulder. The diagnosis is often obvious for complete ruptures because of the deformity of the arm muscle ("Popeye Muscle").

A biceps tendon tear is made more obvious by contracting the muscle ("Popeye Muscle").

Partial ruptures of the biceps tendon are less obvious and to diagnose partial tears, your doctor may ask you to bend your arm and tighten the biceps muscle. Pain when you use your biceps muscle may mean there is a partial tear. Beyond the torn biceps tendon, it is also very important that your doctor identify any other shoulder problems when planning your treatment.

The biceps can also tear near the elbow, although this is less common. A tendon tear near the elbow will cause a "gap" in the front of the elbow. Your doctor will check your arm for damage to this area.

The following diagnostic tests may be done:

1. X-rays. Although X-rays cannot show soft tissues like the biceps tendon, they can be useful in ruling out other problems that can cause shoulder and elbow pain.


2. Ultrasound. Good images and cheaper than MRI. Does not show biceps inside the joint.


3. Magnetic resonance imaging (MRI). These scans create better images of soft tissues. They can show both partial and complete tears.

How are biceps tendon tears treated?

Nonsurgical Treatment

For many people, pain from a long head of biceps tendon tear resolves over time. Mild arm weakness or arm deformity may not bother some patients, such as older and less active people. In addition, if you have not damaged a more critical structure, such as the rotator cuff, nonsurgical treatment is a reasonable option. This can include:

1. Ice. Apply cold packs for 20 minutes at a time, several times a day to keep down swelling. Do not apply ice directly to the skin.


2. Nonsteroidal anti-inflammatory medicines (Voltaren, Brufen, Cataflam, Coxflam, Arcoxia, Celebrex etc.) reduce pain and swelling.


3. Rest. Avoid heavy lifting and overhead activities to relieve pain and limit swelling. Your doctor may recommend using a sling for a brief time.


4. Physical therapy. Flexibility and strengthening exercises will restore movement and strengthen your shoulder.

Surgical Treatment

Surgical treatment for a long head of the biceps tendon tear is rarely needed. However, some patients who require complete recovery of strength, such as athletes or manual laborer, may require surgery. Surgery may also be the right option for those with partial tears whose symptoms are not relieved with nonsurgical treatment.

Several new procedures have been developed that repair the tendon of the biceps with minimal incisions. The goal of the surgery is to re-anchor the torn biceps tendon back to the bone. Complications with this surgery are rare.

Re-rupture of the repaired biceps tendon is uncommon. Successful surgery can correct muscle deformity and return your arm's strength and function to nearly normal.

What to expect after surgery?

After surgery, your shoulder may be immobilized temporarily with a sling. Your orthopedic surgeon will soon refer you to a physiotherapist. Flexibility exercises will improve range of motion in your shoulder. Exercises to strengthen your shoulder will gradually be added to your rehabilitation plan. Be sure to follow your doctor's treatment plan. Although it is a slow process, your commitment to physical therapy is the most important factor in returning to all the activities you enjoy.