What is a Biceps Tendon Rupture?
The biceps muscle is located in the front side of your upper arm and functions to help you bend and rotate your arm.
The biceps tendon is a tough band of connective fibrous tissue that attaches your biceps muscle to the bones in your shoulder on one side and the elbow on the other side.
Overuse and injury can cause fraying of the biceps tendon and eventual rupture.
A biceps tendon rupture can either be partial, where it does not completely tear or complete, where it splits in two and is torn away from the bone.
The biceps tendon can tear at the shoulder joint or elbow joint. Most biceps tendon ruptures occur at the shoulder, which is referred to as a proximal biceps tendon rupture. When it occurs at the elbow it is referred to as a distal biceps tendon rupture and is less common.
Causes of Biceps Tendon Rupture
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 change and overuse. These micro-tears weaken the tendon, making it more susceptible to rupture.
Other causes can include frequent lifting of heavy objects at work, weightlifting, long-term use of corticosteroid medications and smoking.
Symptoms of Biceps Tendon Rupture
The most common symptoms of a biceps tendon rupture include:
- Sudden, sharp pain in the upper arm
- An audible popping sound at the time of injury
- Pain, tenderness, and weakness at the shoulder or elbow
- Trouble turning the arm palm-up or palm-down
- A bulge above the elbow (the “Popeye” sign)
- Bruising to the upper arm
Diagnosis of Biceps Tendon Rupture
Your doctor diagnoses a biceps tendon rupture after observing your symptoms and taking a medical history. A physical exam is performed where your arm may be moved in different ways to see which movements elicit pain or weakness. Imaging studies such as X-rays may be ordered to assess for bone deformities such as bone spurs, which may be the cause, or an MRI scan to determine whether the tear is partial or complete.
Non-surgical treatment is an option for patients whose injury is limited to the top of the biceps tendon. This includes:
- Rest: A sling is used to rest the shoulder, and you are advised to avoid overhead activities and lifting heavy objects until the bicep tendon has healed.
- Ice: Applying ice packs for 20 minutes at a time, 3 to 4 times a day, to help 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.
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 and workers with physically demanding jobs.
Your surgeon makes an incision either near the elbow or the shoulder depending on which tendon of the biceps is torn. The torn end of the tendon is cleaned and sutures are woven through the end of the tendon. The tagged tendon is then secured back to the bone using resorbable anchors or screws that are placed into tunnels created in the bone. The biceps repair near the elbow is called “ distal biceps reinsertion” while the repair of the upper (proximal) biceps tendon near the shoulder is called “ proximal biceps tenodesis
Postoperative recovery includes temporary immobilization in a sling or brace for several weeks as well as several months of physical therapy.
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, potential complications include:
- Nerve damage
- Re-rupture of the tendon