Biceps tendon tears can be either partial or complete and affect the shoulder or the elbow areas.
Partial tears. These tears do not completely sever the tendon.
Complete tears. A complete tear will split the tendon into two pieces.
In most cases, tears of the distal biceps tendon are complete. This means that the entire muscle is detached from the bone and pulled toward the shoulder. Distal biceps tendon rupture is equally likely in the dominant and non-dominant arm.
Other arm muscles can substitute for the injured tendon, usually resulting in full motion and reasonable function. Left without surgical repair, however, the injured arm will have a 30% to 40% decrease in strength, mainly in twisting the forearm (supination).
Rupture of the biceps tendon at the elbow is unusual. It occurs in only one to two people per 100,000 each year, and rarely in women.
The main cause of a distal biceps tendon tear is a sudden injury. These tears are rarely associated with other medical conditions.
Injuries to the biceps tendon at the elbow usually occur when the elbow is forced straight against resistance. It is less common to injure this tendon when the elbow is forcibly bent against a heavy load.
Lifting a heavy box is a good example. Perhaps you grab it without realizing how much it weighs. You strain your biceps muscles and tendons trying to keep your arms bent, but the weight is too much and forces your arms straight. As you struggle, the stress on your biceps increases and the tendon tears away from the bone.
- Men, age 30 years or older, are most likely to tear the distal biceps tendon.
Additional risk factors for distal biceps tendon tear include:
- Smoking. Nicotine use can affect nutrition in the tendon.
- Corticosteroid medications. Using corticosteroids has been linked to increased muscle and tendon weakness
There is often a “pop” at the elbow when the tendon ruptures. Pain is severe at first, but may subside after a week or two.
Other symptoms include:
- Swelling in the front of the elbow
- Visible bruising in the elbow and forearm
- Weakness in bending of the elbow
- Weakness in twisting the forearm (supination)
- A bulge in the upper part of the arm created by the recoiled, shortened biceps muscle
- A gap in the front of the elbow created by the absence of the tendon
Surgical treatment for a long head of the biceps tendon tear is rarely needed. However, some 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.
Several new procedures have been developed that repair the tendon with minimal incisions. The goal of the surgery is to re-anchor the torn tendon back to the bone. Your doctor will discuss with you the options that are best for your specific case.
Complications with this surgery are rare. Re-rupture of the repaired tendon is uncommon.
After surgery, your shoulder may be immobilized temporarily with a sling.
Your doctor will soon start you on therapeutic exercises. Flexibility exercises will improve range of motion in your shoulder. Exercises to strengthen your shoulder will gradually be added to your rehabilitation plan.
Be sure to follow your doctor’s treatment 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.
Successful surgery can correct muscle deformity and return your arm’s strength and function to nearly normal.