The motions required to bend an elbow or rotate an arm are made possible by the biceps. The muscles are located on the upper arm, at the front, and they also assist in maintaining the stability of the shoulder joint. The muscles are attached to bones with tendons. The tendons involved in the use of the biceps muscles span across two joints, the elbow and the shoulder, which makes it unique. If a biceps tendon tear occurs at the shoulder, it will lower the strength of arm and make it physically difficult to move from a palm up to a palm down position.
There are two tendons that attach the upper portion of the biceps to the shoulder bones. The one with a longer head is attached to the glenoid, which is located at the top of the socket of the shoulder. The one with a shorter head is attached to the scapula, which is a bump on the shoulder blade. This is known as the coracoid process.
Above is a visual example of a complete tear of the longer tendon head right at the point that it attaches to the glenoid.
It’s possible for a biceps tendon tear to be either complete or partial. It’s common for these tears to begin with simple fraying. The damage will progress as the muscle is used and can lead to a complete tear. Sometimes this kind of damage is brought on by one, simple task like lifting something heavy.
It is most likely that the long headed tendon of the biceps will be injured. That’s because it is more vulnerable than the short headed tendon. That makes it very fortunate for the structural strength of our anatomy that there are two different biceps attachments located at the shoulder. It is very rare for the shorter tendon head for the biceps to tear. It’s this second attachment that usually allows people to continue to use their biceps even after the longer head has been completely torn.
Like with any other injury, it is easy to injure the surrounding areas once you’ve got a bicep tear. One of the most common places to injure after you’ve got a biceps tear is at the rotator cuff tendons.
When it comes to the causes of bicep tendon tears, there are two main culprits; overuse and injury. It’s easy to tear a tendon if you stretch your arms out in front of you as you fall or if you try to pick something up that’s too heavy.
It’s easy to wear down the tendon so that it frays slowly over time. In fact, that is a natural part of the aging process. But the process is made worse by overuse, like when you continue to repeat the same motions with your shoulder. There are a wide variety of problems and injuries that can be caused by overuse, such as shoulder impingement, tendonitis, and rotator cuff injuries. These other conditions put more stress on the biceps tendons, and that added stress makes it more likely that it will tear or weaken.
- Sharp or sudden pains of the upper arm
- An occasional pop or snap
- Cramps in the biceps that occur whenever the arm is used
- Bruises on the upper arm that span down towards the elbow
- Tenderness or pain that can be felt at either the shoulder or the elbow
- General weakness in the use of the elbow or shoulder
- Finding it to be a struggle to turn the arm away from having its palm up or down
- With the tendon torn, it can no longer make sure that the muscle stays nice and tightly in place, so it is possible that a bulge may appear that can be seen on the upper arm above the elbow. This is known as a “Popeye Muscle” and will result in a dent up closer to the shoulder.
Biceps tendons are too soft to be able to be seen on an X-ray, but that doesn’t mean that the test is completely useless. It can help your orthopedic doctor rule out a variety of other injuries that could be to blame for the shoulder and elbow pain.
The magnetic resonance imagining scan is classically known as the MRI, and that is what a doctor will use in order to get a better look at the soft tissues. This test will reveal both partial and complete tears.
It is common for the pain that follows a biceps tendon tear to soothe itself over time. The symptoms like arm deformity and mild weakness might not be very important to some patients, like people that are less active or older. Nonsurgical treatment is almost always a more than reasonable option for those that haven’t damaged anything that’s too critical.
Pain and swelling can be reduced through the use of nonsteroidal anti-inflammatory medications such as aspirin, ibuprofen, or naproxen. Another simple way to avoid pain and swelling is by the simple act of avoiding overhead activities and heavy lifting. Restoring movement can be achieved through physical therapy, which works while strengthening and improving flexibility.
While the nonsurgical treatments are less invasive, there are patients that will require a complete recovery of their strength as soon as possible. Such patients include athletes and manual laborers. If nonsurgical means fail to relieve symptoms from those with partial tears, surgical means may be the next step.
There are doctors that perform this shoulder surgery as a specialization and prefer to use arthroscopic surgery or mini-open sub-pectoralis repair as a minimally invasive technique. Reattaching the torn tendon to the bone that it is meant to be attached to is the main goal of the surgery. Through a successful surgery muscle deformity can be corrected and the arm should return to its normal level of strength and function. It’s rare that this surgery will yield to any complications, and a second tendon tear afterwards is very uncommon.
A sling will temporarily keep the shoulder immobilized after the orthopedic surgery, which will help in the healing process. The range of motion can be improved through the use of flexibility exercises. Exercises that focus on strengthening the shoulder slowly be added into each patient’s individual rehabilitation plan.
Fully committing to physical therapy is the most important part of returning to full health so that the patient can return to all of their normal day to day activities.
To schedule a consultation with Dr. Samimi to learn more about biceps tendon repair surgery and treatment options click here.