Biceps Tendon Rupture

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.

Overuse and injury leads to 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 biceps tendon completely splits in two and is torn away from the bone.

The biceps tendon can tear at the shoulder or elbow joint. Most biceps tendon ruptures occur at the shoulder and is 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 much less common. 

Causes

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

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 or elbow
• Trouble turning the palm up or down
• Bulge above the elbow (Popeye sign)
• Bruising to the upper arm

Diagnosis

Your doctor diagnoses a biceps tendon rupture after observing your symptoms and taking a 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

Nonsurgical treatment

Nonsurgical treatment is an option for patients whose injury is limited to the top of the biceps tendon.

These may include:

Rest: A sling is used to rest the shoulder and you are advised to avoid overhead activities and heavy lifting until 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.

Physiotherapy: Strengthening and flexibility exercises help restore strength and mobility to the shoulder joint.

Surgical treatment

Surgery may be necessary if your symptoms are not relieved by conservative measures and if you require full restoration of strength, such as in athletes.

Your surgeon makes an incision either near your elbow or shoulder, depending on which end of the tendon is torn. 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

Complications is usually rare following biceps tendon repair; however, complications can occur and may include:

• Infection
• Nerve damage
• Re-rupture of the tendon