Biceps Tendon Tear
Biceps tendon tears can be either partial or complete.
-Partial tears. These tears damage the soft tissue but do not completely sever the tendon.
-Complete tears. A complete tear will detach the tendon completely from its attachment point at the bone.
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.
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
After discussing your symptoms and how the injury occurred, your doctor will examine your elbow. During the physical examination, your doctor will feel the front of your elbow, looking for a gap in the tendon. He or she will test the supination strength of your forearm by asking you to rotate your forearm against resistance. Your doctor will compare the supination strength to the strength of your opposite, uninjured forearm.
In addition to the examination, your doctor may recommend imaging tests to help confirm a diagnosis.
-X-rays. Although x-rays cannot show soft tissues like the biceps tendon, they can be useful in ruling out other problems that can cause elbow pain.
-Ultrasound. This imaging technique can show the free end of the biceps tendon that has recoiled up in the arm.
-Magnetic resonance imaging (MRI). These scans create better images of soft tissues. They can show both partial and complete tears of the biceps tendon.
Surgery to reattach the tendon to the bone is necessary to regain full arm strength and function.
Nonsurgical treatment may be considered if you are older and less active, or if the injury occurred in your nondominant arm and you can tolerate not having full arm function. Nonsurgical treatment may also be an option for people who have medical problems that put them at higher risk for complications during surgery.
Nonsurgical treatment options focus on relieving pain and maintaining as much arm function as possible. Treatment recommendations may include:
• Rest. Avoid heavy lifting and overhead activities to relieve pain and limit swelling. Your doctor may recommend using a sling for a brief time.
• Nonsteroidal anti-inflammatory medications. Drugs like ibuprofen and naproxen reduce pain and swelling.
• Physical therapy. After the pain decreases, your doctor may recommend rehabilitation exercises to strengthen surrounding muscles in order to restore as much movement as possible.
Surgery to repair the tendon should be performed during the first 2 to 3 weeks after injury. After this time, the tendon and biceps muscle begin to scar and shorten, and restoring arm function with surgery may not be possible. While other options are available for patients requesting late surgical treatment for this injury, they are more complicated and generally less successful.
There are several different procedures to reattach the distal biceps tendon to the forearm bone. Some doctors prefer to use one incision at the front of the elbow, while others use small incisions at both the front and back of the elbow.
One method for reattaching the tendon is through a single incision at the inside of the elbow.
A common surgical option is to attach the tendon with stitches through holes drilled in the radius bone. Another method is to attach the tendon to the bone using small metal implants (called suture anchors).
There are pros and cons to each approach. Be sure to carefully discuss the options available with your doctor.
(Left) A suture and suture anchor. (Right) This x-ray taken from the side shows where the suture anchors are placed in the radius bone.
Right after surgery, your arm may be immobilized in a cast or splint.
Your doctor will soon begin having you move your arm, often with the protection of a brace. He or she may prescribe physical therapy to help you regain range of motion and strength.
Resistance exercises, such as lightly contracting the biceps or using elastic bands, may be gradually added to your rehabilitation plan.
Be sure to follow your doctor’s treatment plan. Since the biceps tendon takes over 3 months to fully heal, it is important to protect the repair by restricting your activities.
Light work activities can begin soon after surgery. But heavy lifting and vigorous activity should be avoided for several months.
Although it is a slow process, your commitment to your rehabilitation plan is the most important factor in returning to all the activities you enjoy.
Almost all patients have full range of motion and strength at the final follow-up doctor visit.
After time, return to heavy activities and jobs involving manual labor is a reasonable expectation.