Rupture of the Biceps Tendon

Tendons attach muscle to bone. The biceps muscle in the upper arm splits near the shoulder into a long head and a short head. Both attach to the shoulder in different places. At the other end of the muscle, the distal biceps tendon connects to the smaller bone (radius) in the lower arm. These connections help the muscle stabilize the shoulder, rotate the lower arm and accelerate or decelerate the arm during overhead motions such as pitching.

The long head of the biceps tendon is vulnerable to injury because it travels through the shoulder joint to its attachment point. If the biceps tendon tears, you may lose arm strength and be unable to turn your arm from palm down to palm up. Because the torn tendon can no longer keep the muscle taut, you may also notice a bulge in the upper arm (Popeye muscle). If the distal tendon tears, you may be unable to lift items or bend your elbow.

Possible causes of biceps tendon rupture:

  • Ruptures of the distal tendon near the elbow are rare. They usually occur when an unexpected force is applied to a bent arm.
  • The proximal biceps tendons near the shoulder tear more easily. Tears can be either partial or complete. If you are over the age of 40, these tendons are already frayed and have a history of shoulder pain, and participate in activities that involve overhead motions. Among the elderly, biceps tendon ruptures near the shoulder are often associated with rotator cuff tears.

Signs and symptoms of biceps tendon rupture

  • Sudden, sharp pain in the upper arm.
  • Sometimes, an audible snap.
  • A bulge in the upper arm above the elbow, and a dent closer to the shoulder.
  • Bruising from the middle of the upper arm down toward the elbow.
  • Pain or tenderness at the shoulder.

Diagnosis and treatment

  • Physician will examine your arm and ask you to bend the arm and tighten the biceps muscle.
  • Doctor will apply pressure to the top of the arm to see if there is any pain
  • History of shoulder pain and/or injuries are gathered
  • MRI or X-ray arthrogram to see if rotator cuff muscle is torn

Conservative treatment is usually all that is needed for tears in the proximal biceps tendons.

  • Ice applications keep down the swelling.
  • Nonsteroidal anti-inflammatory medications to reduce pain and inflammation in the shoulder: e.g. ibuprofen or Naprosyn
  • Rest the muscle, limiting your activity when you feel pain or weakness.
  • Begin some home strengthening exercises to keep the shoulder mobile and strengthen the surrounding muscles
  • Surgical repair of a complete tendon tear can be done for younger individuals whose work involves heavy labor or lifting.

Complete tears of the distal biceps tendon require surgery to reattach the tendon to the bone. Range of motion exercises can begin as early as two weeks after surgery, although forceful biceps activity is often restricted for four to six months.

Partial tears of the distal biceps tendon may be treated either conservatively or surgically. You and your orthopedic surgeon should discuss the options for your specific case.

If you have shoulder pain and would like a comprehensive physical examination, Contact Us to schedule an appointment with Dr. Emmanuel.

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