The biceps muscle is present on the front side of your upper arm and functions to help you bend and rotate your arm. The biceps tendon is a tough band of connective fibrous tissue that attaches your biceps muscle to the bones in your shoulder on one side and the elbow on the other side. Overuse and injury can lead to fraying of the biceps tendon and eventual rupture. A biceps tendon tear can either be partial or complete where the biceps tendon completely splits in two and is torn away from the bone. The biceps tendon can tear at the shoulder joint or elbow joint. Most biceps tendon ruptures occur at the shoulder and is referred to as proximal biceps tendon rupture. When it occurs at the elbow it is referred to as a distal biceps tendon rupture. Biceps tendon tears occur most commonly from an injury, such as a fall on an outstretched arm, or from overuse of the muscle, either due to age or from repetitive overhead movements such as with tennis and swimming. Biceps tendon tears are common in people over 60 who have developed chronic micro tears from degenerative changes and overuse. These micro tears weaken the tendon making it more susceptible to rupturing. Other causes can include frequent lifting of heavy objects while at work, weightlifting, long term use of corticosteroid medications and smoking.
The most common symptoms of a biceps tendon tear include: sudden, sharp pain in the upper arm, audible popping sound at the time of injury, pain, tenderness and weakness at the shoulder or elbow, trouble turning the arm palm up or down, a bulge above the elbow (Popeye sign), and/or bruising to the upper arm.
Your doctor diagnoses a biceps tendon tear after observing your symptoms and taking a medical history. A physical exam is performed where your arm may be moved in different positions to see which movements elicit pain or weakness. Imaging studies such as X-rays may be ordered to assess for bone deformities such as bone spurs or an MRI scan can be used to confirm if the tear is partial or complete.
Non-surgical treatment is an option for patients whose injury is limited to the top of the biceps tendon. These options include rest, ice, compression and elevation (RICE) and non-steroidal anti-inflammatory drugs (NSAIDs) to bring down the inflammation and pain. Alternatively, an anesthetic and steroid can be injected in your shoulder and combined with physical therapy may be helpful.
Surgery may be necessary for patients whose symptoms are not relieved by conservative measures and for active patients who require full restoration of strength and function. Your surgeon makes an incision either near your elbow or shoulder, depending on which end of the tendon is torn. The torn end of the tendon is cleaned and the bone is prepared by creating drill holes. Suture anchors are placed in the holes and the tendon to secure it back to the bone and hold it in place. The incision is then closed and a dressing applied.
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Post operative care
Biceps tendonitis is the inflammation of the biceps tendon, the tissue that connects muscle to bone in your upper arm, causing pain in the upper arm and shoulder. It is more common in men in the age group of 40 to 60 years and symptoms may be associated with many sports activities including tennis, baseball, weightlifting and kayaking where overhead movement is involved. Two separate tendons or heads in the upper arm, the long head and short head, converge to form a single muscle called the biceps muscle. The long head passes through the shoulder joint and into the bicipital groove, which is a depression in the arm bone. When the tendon gets inflamed due to stress or injury, as seen in biceps tendonitis, it rubs against the joint or groove, causing pain.
The common causes of biceps tendonitis include overuse of the arm and shoulder especially in sports, inflammatory diseases like bursitis or arthritis, injury or infection. Biceps tendonitis is characterized by pain in the shoulder, which may travel to the forearm, tenderness at the region where the biceps contacts the shoulder, reduced shoulder movement, and a bulge in the biceps if a tendon ruptures.
On presenting with shoulder pain, your doctor will conduct a thorough examination of your shoulder to identify the site of inflammation and the movements that cause pain. X-rays and MRI scan may be suggested to confirm the diagnosis.
First line treatment options include rest, ice, compression and elevation (RICE) and non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain. Alternatively, an anesthetic and steroid can be injected in your shoulder and physical therapy may be of additional benefit. If conservative treatment does not provide relief, surgery is often recommended. Through surgery, the inflamed tissue can be removed (biceps debridement), the long head of the tendon can be cut so that it does not rub against the joint and groove (biceps tenotomy), or the tendon can be cut and reattached lower down the arm (biceps tenodesis).
- Biceps Tendonitis – Understanding the Non-surgical and Surgical Management
- Live Surgical Demonstration: Rotator Cuff Repair and Subpectoral Biceps Tenodesis
- Arthrex – Subpectoral Biceps Tenodesis Using a 1.9 mm FiberTak® Anchor With Needles
- Mini-open Subpectoral Biceps Tenodesis Using All-Suture Anchor