Biceps Tendon Injuries

What are the biceps and biceps tendon injuries?

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 scapula bone 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.

Injuries to the biceps tendons include:

• Proximal biceps tendonitis at shoulder
• Proximal biceps tendon tear at shoulder
• Distal biceps tendonitis and tear at the elbow

What is biceps tendonitis?

Even though tendons are tough, if you overuse them they can become sore and painful. This is caused by micro tears in the tendon and it is called tendonitis (sometimes spelled “tendinitis”).

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 load to the tendon.

You can get biceps tendonitis in the shoulder or at the elbow. It is unusual to have tendonitis in both places at the same time. In the shoulder, biceps tendonitis can occur at the same time as rotator cuff tendonitis as it is part of the rotator cuff complex.

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 and pain caused by tendonitis.
• Nonsteroidal anti-inflammatory medications such as aspirin or ibuprofen will help relieve swelling and pain.
• Your doctor may also recommend rest. It will be particularly important to avoid any heavy lifting, flexing at the elbow and over your head.
• In some cases, your doctor may refer you for physical therapy to help your shoulder or elbow recover.
• In severe cases of tendonitis without a tear, corticosteroid injections may offer relief of pain and halt the inflammatory process and get the tendon back on a path of healing.

Most patients who have had surgery for tendonitis can move their arms without pain and regain a full range of motion.

• 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 of repetitions you do and the amount of force you use, and stop if you feel any unusual pain. Be careful to avoid and then correct underlying conditions such as improper posture or poor technique in sports or work.

What are 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 (for example, a couch or 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 or forearm near the elbow.
• A feeling of weakness in the shoulder or elbow.
• Trouble rotating your arm from a "palm down" to a "palm up" position.
• A change in the contour of the front of your bicep in the upper arm (“Popeye muscle”).

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.

What are shoulder (proximal) biceps tears?

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 front of the shoulder. Tears almost exclusively occur in the long head. Good news is that 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.

How are shoulder biceps tears treated?

Surgery may be a choice for those who continue to experience symptoms after non-surgical treatments and have a cosmetic “Popeye” bicep muscle.

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 uncommon. If you decide to have surgery, you will need to do flexibility and strengthening exercises to rehabilitate your shoulder. This can last for several months.

What are distal biceps tendon tears?

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 and retracted back. This causes weakness in powerful palm-up activities like tightening with a screwdriver with the right hand.

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 palm-up rotation 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 one to two weeks after the tear and surgery becomes more difficult and permanent muscle atrophy occurs with time.

It may take three months or more 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.