Biceps Tendon Rupture at the Shoulder
What is the Biceps Tendon?
The biceps muscle is present on the front 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.
What is a Biceps Tendon Rupture?
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 the tendon or complete, where the tendon completely 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 and are referred to as proximal biceps tendon rupture. When it occurs at the elbow it is referred to as a distal biceps tendon rupture; however, this is less common.
What are the Causes of Bicep 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 changes and overuse. These micro tears weaken the tendon, making it more susceptible to rupture.
Other causes can include frequent lifting of heavy objects while at work, weightlifting, long-term use of corticosteroid medications and smoking.
Symptoms of Bicep Tendon Rupture
The most common symptoms of a biceps tendon rupture include:
- Sudden, sharp pain in the upper arm
- Audible popping sound at the time of injury
- Pain, tenderness, and weakness at the shoulder
- Trouble turning the palm up or down
- Bulge (Popeye sign)
- Bruising to the upper arm
How is a Bicep Tendon Rupture Diagnosed?
Your doctor diagnoses a biceps tendon rupture after observing your symptoms and reviewing your medical history. A physical exam is performed where your arm may be moved in different positions to see which movements elicit pain or weakness. Imaging studies such as X-rays may be ordered to assess bone deformities such as bone spurs, which may have caused the tear, or an MRI scan to determine if the tear is partial or complete.
Treatment Options for Bicep Tendon Rupture
Non-surgical Treatment for Bicep Tendon Rupture
Non-surgical treatment is an option if the injury is limited to the top of the biceps tendon. These may include:
Rest: A sling is used to rest the shoulder. 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, helps 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.
Surgical Treatment for Bicep Tendon Rupture
Surgery may be necessary if symptoms are not relieved by conservative measures and if full restoration of strength is required in case of athletes.
Your surgeon makes an incision either near your shoulder. The torn end of the tendon is cleaned and the bone is prepared by creating drill holes. Sutures are woven through the holes and the tendon to secure it back to the bone and hold it in place. The incision is then closed and a dressing applied.
Risks and Complications of Bicep Tendon Rupture
As with any surgery, complications can occur related to the anesthesia or the procedure. Mostly, you may suffer no complications following biceps tendon repair; however, complications can occur and may include:
- Nerve damage
- Re-rupture of the tendon