You’re probably fairly familiar with the biceps muscles. These upper arm muscles are often flexed to show off one’s strength. Unfortunately, due to overuse or injury, the soft tissues that attach muscles to bones (i.e. your tendons) may tear. A biceps tendon tear, while not very common, can be a serious injury.
So how do these tendons tear and what does that mean for your upper arm?
Let’s start by taking a basic look at the biceps muscle and its tendons.
Your bicep muscles are the large muscle groups at the front of each upper arm. Your biceps (as the name suggests) consist of two heads—the brachii and brachialis—which connect at different areas of the shoulder. In contrast, these muscles connect at the same spot in the elbow where they terminate.
More generally, your muscles are attached to bones via connective tissues known as tendons. These soft tissues are made of strong fibrous material known as collagen. As such, they are able to withstand quite a bit of tension as you go about your daily activities.
Biceps muscles—along with the help of tendons—allow the elbow to flex. Biceps also enable the forearm and hand to rotate.
Unfortunately, despite their strength, your biceps aren’t immune to injury. One of the most common biceps tendon injuries is tendonitis. This occurs when the tendons become inflamed because of overuse. Chronic tendonitis can weaken tendons by causing small tears. These small tears can eventually lead to an even more serious injury—the dreaded biceps tendon tear.
As the name suggests, this injury occurs when the tendon is torn. Specifically, one can suffer two types of biceps tendon tears:
Furthermore, these injury types can occur in both the shoulder and elbow.
Tendon tears that occur at the elbow are known as distal biceps tendon tears. They are mainly caused by a sudden injury in which the tendon is violently forced straight. (For instance, if you were to lift something heavy—like furniture—with your palms facing upward.) The tear can occur as the weight of the object forces your arm straight while you attempt to resist.
More commonly, however, a biceps tendon tear occurs at the shoulder. Proximal biceps tendon tears may be due to heavy lifting or falling with an outstretched arm. Unlike distal biceps tendon tears, overuse is the most common cause of bicep tendon injuries at the shoulder.
Most proximal biceps tendon tears occur at the top of the shoulder socket. Tearing at the tendon connected to a bump on the shoulder blade is much less common.
There are some factors that make a biceps tendon tear more likely. These include:
So how do you know if you have a biceps tendon tear in the shoulder or elbow? The next section will highlight the common symptoms.
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A tendon tear is often accompanied by a popping sound or sensation at the location of the injury. This can occur during a fall, while lifting a heavy object, or during some other form of excessive physical strain to the area.
Since a biceps tendon tear can occur at different locations, let’s look at specific symptoms for each injury.
Many soft tissue injuries often exhibit similar symptoms. To effectively treat your pain and discomfort, you want to make sure you receive an accurate diagnosis. This can rule out other conditions like severe tendonitis or rotator cuff injuries.
Diagnosis starts with a complete medical history. Your doctor will review any previous injuries or medical conditions. In addition, you will need to describe your symptoms and the events leading up to them.
A physical examination will determine if there are any deformities in the upper arm—such as “Popeye muscle”. The doctor may ask you to flex the biceps, rotate your forearm, and bend at the elbow to examine your pain level and functioning.
To confirm a biceps tendon tear and/or rule out other injuries, imaging tests may be ordered. X-rays, for example, can be used to detect any damage to the bones. Likewise, MRIs and ultrasound tests will allow your doctor to take a more careful look at your tendons and other soft tissues.
Once you’ve been properly diagnosed, treatment can promptly begin. Check out the next section for complete and partial biceps tear treatments.
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The severity and location of your biceps tendon tear often determine your treatment. Partial tears may not require surgery. Complete tears, on the other hand, may necessitate surgery within a couple of weeks of the injury.
Let’s take a look at your treatment options for a biceps tendon tear:
As mentioned earlier, two tendons connect to the biceps at the shoulder. As a result, many people with a proximal biceps tendon tear can benefit from conservative treatments. For some, even a complete tear can be managed with nonsurgical treatments. This is especially true when there isn’t any other damage to another shoulder area like the rotator cuff.
Conservative treatments for a biceps tendon tear include:
Proximal biceps tendon rupture, surgery or not?
Choosing surgery depends on a variety of factors including: your overall health, treatment goals, and response to conservative treatments. For example, if you are an athlete who wishes for a full recovery of strength and flexibility, surgery may be an option. Many people, however, don’t require surgery.
There are a couple of different surgical options based on the severity of your injury. These include:
After surgery, you may have to wear a shoulder sling for a short period of time. Also, a guided regimen of physical rehabilitation can increase strength and flexibility in the area.
For this less common biceps tendon tear injury, choosing surgery may be the best option.
In time, the muscle and torn tendon may shorten and scar. Waiting too long can complicate surgery.
Of course, some people may not be ideal candidates for surgery. For example, younger and more active individuals may not tolerate having less function in the arm. Also, those with medical conditions that might complicate surgery may instead opt for more conservative treatment.
Conservative treatments for a distal biceps tendon tear are similar to those for proximal tears—rest, medications, and physical therapy.
Surgery for distal bicep tendon repair can include:
After surgery, you may be put in a cast to immobilize the area. Then, as you begin to recover, you will start physical therapy and may have to wear a protective brace. A full recovery is certainly possible if you follow your rehabilitation plan.
Suffering a biceps tendon tear certainly has its own unique set of challenges. Pain, loss of arm function, and that unsightly bulge in the upper arm can definitely detract from your enjoyment of life. Finding an experienced team of orthopedic doctors and rehabilitation specialists can put your life back on track.
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