Repairing A Bicep Tendon Rupture or Tear - Houston, Beaumont, Cypress TX
The biceps muscle is present on the front side 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 lead 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 joint or elbow joint. Most biceps tendon ruptures occur at the shoulder and are 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.
What Causes Bicep Tendons To Rupture?
Biceps tendon ruptures occur most commonly from an injury, such as a fall on an outstretched arm, the act of lifting heavy objects, or the overuse of the muscle, either due to age or from repetitive overhead movements such as with tennis and swimming. In the case of overuse, a tendon may fray and eventually tear. Other shoulder problems such as tendonitis, shoulder impingement, and rotator cuff injuries are more likely to weaken or tear the biceps tendon.
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.
Additional risk factors such as advancing age, heavy overhead activities, repetitive overhead sports, smoking, and use of corticosteroids can also result in a tendon tear.
What are the Symptoms of Bicep Tendon Tears?
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 arm palm up or down
- Bulge above the elbow (Popeye sign)
- Bruising to the upper arm
What are the Types of Bicep Tendon Tears?
Biceps tear can be complete or partial. Partial biceps tendon tears will not completely break the tendon. Complete tendon tears will break the tendon into two parts.
- Biceps tendon tears at the shoulder: Two tendons that attach the biceps muscle to the bones in the shoulder, the long head tendon that attaches the muscle to the top of the shoulder’s socket (glenoid) and the short head that attaches it to the shoulder blade. Tears are more likely to occur in the long head of the biceps tendon. Tears of the short head of the biceps are very rare. But even in case of a complete tear of the long head, the short head of the biceps may allow you to continue using your biceps muscle.
Biceps tendon tears at the elbow: Although two tendons attach the biceps muscle to the bone at the shoulder, only one tendon attaches it to the elbow. This is known as the distal biceps tendon. Tears of the distal biceps tendon are usually complete and the muscle is separated from the bone. Tears of the distal biceps tendon most often result from a sudden injury or lifting a heavy object.
How Do You Diagnosis a Bicep Tendon Rupture?
Biceps tendon tear is usually diagnosed based on your symptoms, medical history, and physical examination. During the physical examination, your doctor will look for a gap in the front of the elbow. Your doctor will diagnose a partial tear by asking you to bend your arm and tighten the biceps muscle. You may have pain if there is a partial tear. X-rays may be taken to rule out other conditions causing shoulder and elbow pain. Using an MRI scan your doctor can know whether tear is partial or complete.
What are Treatment Options for Bicep Tendon Ruptures?
Nonsurgical Treatment: Nonsurgical treatment is an option for patients whose injury is limited to the top of the biceps tendon.
Nonsurgical treatment includes:
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.
Physical therapy: Strengthening and flexibility exercises help restore strength and mobility to the shoulder joint.
What Surgical Treatments For Bicep Tendon Tears?
Surgery may be necessary for patients whose symptoms are not relieved by conservative measures and for patients who require full restoration of strength, such as 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.
Surgery to reattach the torn tendon back to the bone is rarely needed. However, for patients with partial tears who continue to experience symptoms after non-surgical treatments or who want all of their arm strength back, such as athletes or manual laborers, surgery may be the best option. Complications are rare and a re-tearing of the repaired tendon is rare. Following surgical repair, you will need to do flexibility and strengthening exercises to improve the range of motion in your shoulder.
Your surgeon may opt for several surgical procedures for distal bicep tendon tear where the distal biceps tendon is reattached to the forearm bone. Some doctors would instead use two incisions, while some use only 1 incision. Both procedures carry certain advantages and disadvantages. During the procedure, the tendon is attached with stitches through holes drilled inside the bone or small metal implants may be used to attach the tendon to the bone.
What Risks and Complications With Bicep Tendon Surgery?
As with any surgery, complications can occur related to the anesthesia or the procedure. Most patients suffer no complications following biceps tendon repair, however, complications can occur and may include:
- Nerve damage
- Re-rupture of the tendon