Biceps Tendon Tear (Rupture) at the Shoulder
The biceps is a strong muscle in front of the upper arm that allows bending the elbow and rotating the arm. It also helps acts to keep the shoulder joint stable. Tendons attach muscles to bones. The biceps is unique in that it has tendons that span 2 joints: the shoulder and the elbow. A biceps tendon tear at the shoulder will cause decreased strength in your arm and make it difficult to forcefully turn your arm from palm down to palm up.
Anatomy
The upper end of the biceps muscle has two tendons that attach it to bones in the shoulder. The long head attaches to the top of the shoulder socket (glenoid). The short head attaches to a bump on the shoulder blade (scapula) called the coracoid process.
A complete tear of the long head at its attachment point in the glenoid.
Biceps tendon tears can be either partial or complete. In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.
The long head of the biceps tendon is more likely to be injured. This is because it is vulnerable as it travels through the shoulder joint to its attachment point in the socket. Fortunately, the biceps has two attachments at the shoulder. The short head of the biceps rarely tears. Because of this second attachment, many people can still use their biceps even after a complete tear of the long head.
When you tear your biceps tendon, you can also damage other parts of your shoulder, such as the rotator cuff tendons.
Cause
There are two main causes of biceps tendon tears: injury and overuse.
If you fall hard on an outstretched arm or lift something too heavy, you can tear your biceps tendon.
Many tears are the result of a wearing down and fraying of the tendon that occurs slowly over time. This naturally occurs as we age. It can be worsened by overuse - repeating the same shoulder motions again and again. Overuse can cause a range of shoulder problems, including tendonitis, shoulder impingement, and rotator cuff injuries. Having any of these conditions puts more stress on the biceps tendon, making it more likely to weaken or tear.
Symptoms
- Sudden, sharp pain in the upper arm
- Sometimes an audible pop or snap
- Cramping of the biceps muscle with strenuous use of the arm
- Bruising from the middle of the upper arm down toward the elbow
- Pain or tenderness at the shoulder and the elbow
- Weakness in the shoulder and the elbow
- Difficulty turning the arm palm up or palm down
- Because a torn tendon can no longer keep the biceps muscle tight, a bulge in the upper arm above the elbow ("Popeye Muscle") may appear, with a dent closer to the shoulder.
Imaging Tests
Although X-rays cannot show soft tissues like the biceps tendon, they can be very useful for your orthopedic doctor in ruling out other problems that can cause shoulder and elbow pain.
Magnetic resonance imaging (MRI) scans create better images of soft tissues. They can show both partial and complete tears.
Nonsurgical Treatment
For many people, pain from a long head of biceps tendon tear resolves over time. Mild arm weakness or arm deformity may not bother some patients, such as older and less active people. In addition, if you have not damaged a more critical structure, such as the rotator cuff, nonsurgical treatment is a reasonable option.
Nonsteroidal anti-inflammatory medications like ibuprofen, aspirin, or naproxen reduce pain and swelling. Avoiding heavy lifting and overhead activities may relieve pain and limit swelling. Physical therapy may help with flexibility and strengthening exercises that will restore movement and strengthen your shoulder.
Surgical Treatment
Patients who require complete recovery of strength, such as athletes or manual laborers, may require surgery. Surgery may also be the right option for those with partial tears whose symptoms are not relieved with nonsurgical treatment.
Dr. Samimi specializes in performing this shoulder surgery using minimally invasive techniques of arthroscopic surgery or mini-open sub-pectoralis repair. The goal of the surgery is to re-anchor the torn tendon back to the bone. Dr. Samimi will discuss with you the options that are best for your specific case. Successful surgery can correct muscle deformity and return your arm's strength and function to nearly normal. Complications with this surgery are rare and re-rupture of the repaired tendon is uncommon.
Rehabilitation
After biceps tendon repair surgery, your shoulder may be immobilized temporarily with a sling.
Flexibility exercises will improve range of motion in your shoulder. Exercises to strengthen your shoulder will gradually be added to your rehabilitation plan.
Although it is a slow process, your commitment to physical therapy is the most important factor in returning to all the activities you enjoy.
Dr. Samimi is a L.A. orthopedic surgeon offering biceps tendon repair surgery at 3 location in West Covina, Encino and Brentwood / West LA.
