The biceps muscle is located at the front of your upper arm. The muscle has two tendons that attach it to the bones of the shoulder and one tendon that attaches to the radius bone at the elbow. The tendons are tough strips of tissue that connect muscles to bones and allow us to move our limbs.
What is tendonitis?
Even though tendons are tough, if you overuse them they can become sore and painful. This is called tendonitis.
Tendonitis can occur because of repetitive motion. For instance, professional baseball players, swimmers, tennis players, and golfers are at risk for tendonitis in their shoulders, arms, and elbows. Tendonitis can also occur because of a sudden, serious injury to the tendon.
How is biceps tendonitis treated?
Although biceps tendonitis can be painful, if properly treated early, it can usually be resolved completely:
- Cold packs or ice will reduce swelling caused by tendonitis.
- Nonsteroidal anti-inflammatory medications such as aspirin or ibuprofen will help relieve pain.
- Your doctor may also recommend rest. It will be particularly important to avoid any heavy lifting, especially over your head.
- In some cases, your doctor may refer you for physical therapy to help your shoulder or elbow recover.
- In severe cases, surgery may be needed to help biceps tendonitis fully heal. In this type of surgery, the lining around the tendon is opened and the inflammatory tissue is removed. The tendon is inspected for tears and, if found, they are repaired. Occasionally, a tendon will need to be lengthened or shortened, depending on the problem.
- Most patients who have had surgery for tendonitis can move their arms without pain and regain a full range of motion, although they may need to limit heavy overhead lifting or some strenuous sports.
- Because most cases of tendonitis are caused by overuse, the best treatment is prevention. It is important to avoid or alter the activities that cause the problem. When doing physical activities, take it slowly at first and gradually build up your activity level, limit the number repetitions you do and the amount of force you use, and stop if you feel any unusual pain. Be careful to avoid or correct underlying conditions such as improper posture or poor technique in sports or work.
Biceps tendon tears
In cases of serious or constant overuse, a tendon may fray and eventually tear. A tendon can also tear as part of an injury, such as moving or twisting your elbow or shoulder in an awkward way, or falling down with your arm outstretched. At the elbow, the bicep tendon most often tears during the act of lifting a heavy object (eg, a refrigerator).
A biceps tendon tear can happen at either the shoulder or the elbow. A tear can also be complete or partial. A complete tear means the tendon has torn away from the bone.
What are the symptoms of a biceps tendon tear?
The most obvious symptom will be a sudden, severe pain in the upper part of your arm or at the elbow, depending on where the tendon is injured. You may hear or feel a "pop" when a tendon tears. Other signs that you may have torn a biceps tendon can include:
- Sharp pain at the shoulder or elbow
- A bruise that appears on the upper arm
- A feeling of weakness in the shoulder or elbow
- Trouble rotating your arm from a "palm up" to a "palm down" position
- A change in the contour of the front of your arm
Also, a bulge may appear in your arm, because the tendon is no longer holding the muscle in place properly.
While surgery may be needed to fix a torn tendon, in many cases people with a torn tendon can still function normally. Symptoms can be relieved using the same treatments that are used to treat tendonitis. Tears at the level of the elbow more often require operative repair.
Tears at the shoulder
Two tendons attach the biceps muscle to the shoulder: the "long head" tendon that attaches the muscle to the top of the shoulder’s socket and the "short head" that attaches it to the shoulder blade. Tears are more likely to occur in the long head. But even in the case of a complete tear of the long head tendon, the short head tendon may allow you to continue using your biceps muscle. Tears of the short head are very rare.
How are the shoulder tears treated?
Some people may opt for non-surgical treatment of a tear of the long head tendon, although they might never regain all of their arm’s original strength. However, for those who continue to experience symptoms after non-surgical treatments or who want all of their arm strength back, surgery may be the best option.
Surgery to reattach a long head tendon is quite safe, with few complications. It can return nearly all of your arm strength and function, and a re-tearing of the repaired tendon is rare. If you decide to have surgery, your will need to do flexibility and strengthening exercises to rehabilitate your shoulder. This can last for several months.
Tears at the elbow
While two tendons attach the biceps muscle to the bone at the shoulder, only one tendon attaches it to the elbow. This is called the distal biceps tendon.
Tears of the distal biceps tendon are unusual and most often result from an injury or lifting a heavy object. When this tendon tears, however, the tear is usually complete and the muscle is separated from the bone.
How is a torn distal biceps tendon treated?
While most people with a torn distal tendon will still be able to move their arms reasonably well, they will usually see a decrease in arm strength. Because of this, many of them may choose surgical treatment. However, those who decide to have surgery will need to do so quickly, because both the distal tendon and the muscle begin to scar two to three weeks after the tear and surgery may not be possible.
It may take two to three months of physical therapy for a surgically repaired distal tendon to heal completely. When it does, patients usually enjoy a full range of motion and near-normal arm strength.
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