Biceps Tendon Tear
The bones that make up the shoulder are the upper end of the arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). Some would describe this joint as a ball and socket type, but in reality, it is more like a ball sitting on a golf tee, meaning that there is a tiny surface area of bone contact. The stability of the shoulder joint relies heavily on the soft tissues around the bone, including muscles, tendons, capsule, and labrum, that keep the arm centered with the shoulder blade. The collarbone or clavicle is another structure in the shoulder region that attaches to the shoulder blade at the front of the shoulder; this joint is called the acromioclavicular joint (AC joint).
The biceps brachii muscle runs from the shoulder to the forearm and is one of the main muscles that bend the elbow. At each end of the muscle, cord-like structures called tendons attach the muscles to the bones. There are two tendons near the shoulder – the long head, and the short-head tendons of the bicep muscles.
In biceps tendon injuries, the long head is most often affected due to its anatomic location.
A rotator cuff is a group of muscles responsible for shoulder movements. They lift the arm, help rotate it, and allow you to pull objects toward you. They also play a role in keeping the arm bone centered over the shoulder blade.
Biceps Tendon Tear
Biceps tendon tears can be incomplete (partial tear) or complete (full tear). They may be caused by an acute injury or overuse of the shoulder, and sudden force to the shoulder or lifting something weighty can cause the tendon to rupture.
Chronic overuse of the shoulder can cause inflammation of the tendons. This can create pain typically at the front of the shoulder, weakness with shoulder movement, particularly with the overhead lifting of the arm, and stiffness, which is a loss of usual motion. Tendons are covered by a skinny layer of tissue called the sheath. When there is inflammation, the sheath may swell. Over time, with persistent rash, the tendon may start to degrade and fray.
In some cases, the tendon may tear entirely, leaving the arm with a bulge at the biceps muscle. The long head of the biceps tendon is more vulnerable to injury and tears due to its physical location. The biceps tendon can also tear at the other end of the muscle near the elbow.
Biceps tendinitis is usually associated with another condition, such as rotator cuff injury.
Symptoms of a biceps tendon tear may include sudden pain in the upper arm or shoulder, an audible snapping sound with hefty lifting at the affected arm, bruising in the upper arm, cramping or pain with movement of the shoulder or elbow, pain with turning the palm up or down on the affected side. A complete tendon tear may result in a bulge, creating a “Popeye” arm appearance.
Physical examination: A medical practitioner may examine the shoulder to check for a range of motion, apply pressure to various areas of the shoulder to see if this causes pain, and check nerve function in the muscles and skin of the arm/hand. They may perform special tests to check for injuries to specific shoulder parts.
Imaging: Based on the history of the shoulder symptoms and the practitioner’s physical examination, imaging can be beneficial in identifying the critical cause of the shoulder complaint. X-rays may be ordered, but they are best used to assess bones and joints.
MRI can provide more detail about the condition of the tendon and muscles. It is also an effective way to look for associated conditions such as a rotator cuff or labral injury.
Rest: Taking a break from activities that put stress on the shoulder can help decrease inflammation. Partial tears usually heal with conservative forms of treatments.
Ice: Ice can decrease inflammation during an acute flare-up.
Anti-Inflammatory Medications: These oral medications are usually found over the counter, are designed to decrease inflammation, and can be effective for short-term use.
Exercises/Physical Therapy: This may dramatically reduce symptoms and help the patient regain strength as the patient heals their injury. It is important to note that consistency with physical therapy, usually for at least 4-6 weeks, is the most beneficial.
Corticosteroid Injections: Steroid medications are very effective in decreasing inflammation. When injected directly into the shoulder, it may provide significant relief, which may help the patient to participate in exercises or physical therapy. In rare cases, however, steroids may worsen tearing in a tendon.
Surgery: Surgery may be indicated in cases where the more conservative treatments mentioned above do not work, and it may also be needed if the tendon is completely torn. Many of these surgeries can be done arthroscopically using small incisions and cameras, making the surgery less invasive.
Surgery for a biceps tendon tear can involve reattaching the torn or painful tendon to a different location in the shoulder where it won’t cause pain, this is a procedure called Biceps Tenodesis. Occasionally, the painful biceps tendon may be released without reattaching it, in a procedure called Biceps Tenotomy. Both procedures are effective at relieving pain related to biceps tendon tears. Your surgeon can discuss which procedure would be best for you.
After surgery, there may be a temporary period of immobilization and limited use of the surgical arm. Physical therapy is often ordered after surgery and can significantly contribute to regaining function and strength in the injured arm after repair.