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.
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.
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).
Risk for a tendon tear in the biceps increases with:
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:
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:
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.
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.