Anatomy of the Biceps Tendon
The biceps muscle, located in the front of the upper arm allows you to bend the elbow and rotate the forearm. Biceps tendons attach the biceps muscle to the bones in the shoulder and in the elbow. The biceps tendon that attaches the muscle at the elbow is known as the distal biceps tendon. In the shoulder there are two tendons that attach the bicep muscle. The long head of biceps tendon runs up a groove at the front of the humerus bone and then runs through the shoulder joint to attach at the top of the socket. The short head attaches to a bony prominence of the scapula (shoulder blade) called the coracoid process.
What is a Bicep Tendon Tear?
A biceps tear can be complete or partial. Partial biceps tendon tears mean there is still some attachment of the tendon to the bone, while complete tendon tears mean the tendon has become completely detached from the bone.
Causes of Bicep Tendon Tears
A biceps tendon tear is most commonly caused by an injury where your elbow is forced against resistance or while lifting heavy objects. Other problems such as tendonitis (gradual wear and tear) are more likely to weaken or tear the biceps tendon, especially the long head of the biceps tendon in the shoulder. Additional risk factors such as advancing age, smoking and use of corticosteroids can also predispose people to a tendon tear.
Symptoms of Bicep Tendon Tears
The most common symptom of a biceps tendon tear is sudden, severe pain at the shoulder or elbow, depending on where the tear has occurred. At times, you may hear a pop. Other symptoms may include swelling, visible bruising, weakness in the shoulder or elbow, and trouble twisting the forearm. A bulge in the upper region of your arm, because the tendon is no longer holding the muscle in place properly, and a gap in the front of the elbow because of the absence of the distal tendon.
Diagnosis of Bicep Tendon Tears
A biceps tendon tear is usually diagnosed based on your medical history and a physical examination. During the physical examination, your doctor will look for a gap in the front of the elbow if there is concern that the distal tendon has ruptured. Your doctor will diagnose a partial tear by asking you to bend your arm and tighten the biceps muscle. You may have pain if there is a partial tear. X-rays may be taken to rule out other conditions causing shoulder or elbow pain. Using an MRI scan, your doctor can confirm if the tear is partial or complete and also exclude other damage.
Treatment Options for Bicep Tendon Tears
Proximal (upper) Bicep Tendon Tears
Conservative treatment is usually recommended for proximal (long head) biceps tendon tears. This is because the short head always remains attached and rupture of the long head of biceps rarely results in any functional impairment.
This may include:
- Ice application
- Limiting activity
- Non-steroidal anti-inflammatory medications to reduce the pain and swelling
- Flexibility and strengthening exercises to restore the mobility and strength of the surrounding muscles
Surgery to reattach the torn tendon back to the bone is rarely needed in long head of bicep tendon tears. However, there may be damage to the surrounding rotator cuff tendons which may need surgical treatment. Occasionally surgery may be indicated for patients with partial tears who continue to experience symptoms after non-surgical treatments or who want all their arm strength back, such as athletes or manual labourers.
Distal Bicep Tendon Tears
Your surgeon will usually opt for surgical treatment for a distal bicep tendon tear, where the distal biceps tendon is reattached to the forearm bone. If this is not undertaken there will be loss of function of the biceps muscle resulting in a loss of elbow flexion strength and especially loss of strength to forearm supination (rotation). One or two incisions may be used. During the procedure, the tendon is attached with stitches through holes drilled inside the bone or small metal implants may be used to attach the tendon to the bone.
Delay of surgery should be avoided as a chronic tear can develop scar tissue and muscle atrophy and is difficult to repair. A tendon graft may be used to repair a chronic tendon rupture.
Following surgery, your arm will be immobilized for a few weeks to allow healing, and physical therapy is recommended for rehabilitation. It usually takes 4-6 months to return to full activity.