You’ve decided to commit to getting healthy by getting back in the gym. It’s been a while since you weight-trained, but you aren’t concerned. The exercise feels good, and your muscles burn while you curl a heavy barbell. On your fourth rep, you hear a sudden loud “pop” and feel sharp pain in the arm holding the weight. You drop the barbell and grasp your injured arm to support it. What happened?
MOSH has complete care and rehabilitation treatment plans for any type of orthopedic injury, including bicep tendon tears. To understand what just happened, you need to understand your arm’s basic anatomy and the injuries it can sustain.
Proximal Bicep Tendon Tears at the Shoulder
Tendons attach muscle to bone. Torn bicep tendons at the shoulder are called proximal bicep tears. They involve the long-head tendon (which attaches the bicep to the shoulder socket) or the short-head tendon (which connects the bicep to the shoulder blade). 96% of bicep tendon ruptures happen to the long-head tendon. Only 1% involve the short-end tendon.
- An injury to the long-head tendon is more likely from overuse and repetitive motions that fray the tendon or from a sudden, acute injury, like a fall. Athletes who throw overhead and jobs that require excessive heavy lifting or overuse of the shoulder are particularly susceptible to these injuries. Bicep tendon injuries are common in sports like tennis, swimming, weightlifting, baseball, and football.
- An injury to the short-head tendon is much less likely, and a non-injured short-head tendon may help compensate for a damaged long-head tendon. Short-head tendon tears are often part of a rotator cuff tear or other shoulder injuries.
In the event of either of these ruptures, you may still be able to use your arm, and your pain may decrease within a few days, even with partial tears.
Distal Bicep Tendon Tears at the Elbow
A tear in the distal bicep tendon means the tendon attaching the bicep to the elbow is damaged. A full range of motion is still possible because other muscles will compensate. Distal bicep tendon ruptures happen to 3 to 5 people per 100,000 a year and primarily to men over thirty. Most injuries are caused by catching or lifting a heavy item during athletic events or manual labor.
You will likely either have a shoulder (proximal) or elbow (distal) tendon tear. It is very rare to have both at the same time.
Types of Bicep Tendon Tear Injuries
Three rupture injuries can occur to the tendons of the biceps:
- A partial bicep tendon rupture means some of the tendon is still attached to the bone, or the muscle is fully attached, but the tendon is badly damaged.
What should you do now? If you suspect a bicep tendon tear, follow these steps to learn what to do and how MOSH can help.
Step 1: Assess Your Signs and Symptoms
Bicep tendon tear symptoms depend on the tendons affected and the severity of the injury. Signs and symptoms of an injury to either location can include:
- Pain, sometimes sharp and sudden, in your arm.
- A “popping” noise, usually near the elbow.
- Bruising and swelling near your elbow or shoulder.
- Inability to rotate your hand from palm down to palm up.
- Trouble moving your elbow, hand, arm, or shoulder.
- A warm sensation at the injury site.
- Weakness in the shoulder, arm, or elbow; a feeling of lost strength.
- Muscle cramping or twitching.
- A bulge in your upper arm called a Popeye deformity (the bicep has become detached from your elbow and is in a ball under your shoulder).
- A gap or depression near the front of your elbow.
Suspecting a bicep tendon tear also involves a basic understanding of your arm’s anatomy. The bicep muscle is on the front of the upper arm. The bicep’s primary purpose is to bend the elbow and help the forearm turn your hand from palm down to palm up.
Step 2: See a Doctor
Tendons do not reattach themselves. Whether you have a partial or complete bicep tendon tear, or tendonitis and inflammation from overuse, you need to see an orthopedic specialist like the doctors at MOSH.
How Are Bicep Tendon Tears Diagnosed?
The first thing your physician will do is get a medical history. They will want to know other injuries you may have had, the details surrounding your current injury, and the types of activities you do to check for risk factors.
Secondly, your doctor will perform a physical examination to determine external signs and symptoms of a bicep tendon tear or another injury. They may test your range of motion, strength, and which movements cause pain or discomfort.
Your doctor will need to perform imaging tests of the injury with an X-Ray, ultrasound, or an MRI scan (magnetic resonance imaging.)
Once the physical examination and imaging is complete, your doctor will diagnose your injury and provide you with a treatment plan and options for repairing the tendon.
Step 3: Follow Your Treatment Plan
Once a doctor has determined what the problem is, they will recommend surgical or non-surgical treatment plans based on the severity of your injury, your age, your tolerance to discomfort and your other needs. For example, if you are an older person with a small tear in one of the shoulder tendons, you might choose a non-surgical treatment because you are okay with reduced function in your arm and aren’t in any need to get back to intense activities. On the other hand, an athlete with a small shoulder tear may choose surgery to ensure function and strength recovery so they can continue in their sport.
Non-Surgical Treatment Options for a Bicep Tendon Tear
Many people have a high level of function with shoulder tendon tears and can consider non-surgical treatments for symptom management. Surgery may be beneficial if:
- Non-surgical interventions don’t relieve symptoms.
- You have intolerable muscle pain or cramping.
- You need full strength in your arm.
- You have lost significant arm function.
For tendonitis or a small or partial tear, non-surgical treatment options include:
- A modification in activities.
- Over-the-counter medications like non-steroidal anti-inflammatories (NSAIDs).
- Braces or slings.
- Rest or immobilization.
- Cold therapy (icing the affected areas with cold packs).
- Platelet Rich Plasma therapy (PRP).
- Physical therapy.
Surgical Treatment Options for Shoulder Tendon Tears
Surgery is a common and safe option as well. Surgery will likely be the first recommendation for a distal bicep tendon injury at the elbow, and is also recommended if:
- Non-surgical options aren’t relieving symptoms.
- More than 50% of your tendon has ruptured.
- The tendon tear is complete.
- The tendonitis has become problematic or doesn’t improve after a year.
A distal tendon tear is usually complete and is likely to require surgery to repair and reattach the bicep to the elbow. Without surgery, the affected arm can have a 30% to 40% decrease in strength. Surgery to fix a partial or complete tear needs to be done within the first 3 weeks of the injury. Scar tissue can develop on the bicep and tendon and shorten their lengths, which will make restoring full function to the arm difficult at best.
Recovery times for surgery vary, but usually you can return to your normal activities in four months. You will likely also need physical therapy to regain full function. Complete recovery can take anywhere from four months to one year.
Step 5: Learn Risk Factors And Prevention Methods
The best way to prevent bicep tendon ruptures is to be aware of the amount of resistance you are putting on the bicep as well as the elbow and shoulder joint. Other prevention tips entail:
- Maintaining strength and flexibility in the arm.
- Using caution when lifting or lowering heavy objects.
- Smoking cessation.
- Warming up before heavy bicep use, especially in activities that involve raising the arm above the head or repetitive elbow or shoulder use.
- Avoiding the use of anabolic steroids.
- Gradually increasing the intensity of new activities.
- Using proper form and equipment when performing activities, fitness routines, or playing sports.
Bicep tendon tears can happen at the elbow or the shoulder. Not all bicep tendon ruptures are serious, and some can be managed with non-invasive therapies. If you suspect a bicep tendon tear, consult with one of our orthopedic specialists as soon as possible. MOSH offers state-of-the-art surgical and non-surgical treatment options and experienced orthopedic rehabilitation teams. Contact us at 414-817-5800, or visit the Performance Center Clinic, our premier orthopedic care with convenient walk-in appointments.