The biceps is located at the front of the upper arm. There are three biceps tendons. Two attach to the shoulder and one attaches to the elbow. The tendons function in the motion of both the elbow and the shoulder.
Biceps tendon tears can occur when the tendons are overused and exposed to repeated stress. This can cause a tendon to fray, and thus eventually tear. Tendons can also tear when there is an injury to this part of the arm, such as oddly moving or twisting the elbow or shoulder, or falling on an outstretched hand.
Bicep tendon tears can occur at either the shoulder or the elbow, and tears can be complete or partial. When a complete tear occurs, the tendon has torn away from the bone.
Biceps Tendon Tears Symptoms
A sudden, severe pain in the upper part of the arm or at the elbow is the most obvious symptom of a biceps tendon tear. Additionally, a popping sound or sensation may be experienced when the tendon tears. Other signs of a biceps tendon tear include:
- The appearance of a bruise on the upper arm
- Sharp pain in the shoulder or elbow
- Weakness in the shoulder or elbow
- Difficulty rotating your forearm with the elbow bent
- A change in the contour of the front of the arm
- A bulge in the arm
Causes and Risk Factors
There are several causes and risk factors associated with a biceps tendon tear.
There are two main causes, which include:
- Trauma – lifting an extremely heavy object that overpowers the muscle, or falling on an outstretched hand.
- Overuse – Overuse wears down and frays the tendon, eventually leading to a tear. This occurs gradually, over time, and tends to occur naturally with age. Sports that involve repetitive throwing increase the possibility of a tear due to overuse.
The following increases the risk of tearing the biceps tendon:
- Age – It is more common in older people, as their biceps tendon has had more wear and tear
- Heavy overhead activities – Lifting heavy objects over the head, such a s in weightlifting, can cause excess wear and tear on the tendon
- Overuse of the shoulder – Overusing the shoulder in sports increases the risk of this condition. Swimmers, throwing athletes and tennis players often tear their biceps tendon
- Corticosteroid medications – This can cause muscle and tendon weakness
Initially, your doctor will take a full medical history and conduct a physical examination. A physical examination is typically only effective for a complete rupture, as the deformity of the arm muscle is obvious. Your doctor may also ask you to bend your arm and tighten your biceps muscle. If you experience pain while doing so, this could indicate a partial rupture.
An MRI scan may also be ordered to diagnose a partial or complete rupture. X-rays may be useful to rule out other problems that is causing elbow and shoulder pain, although X-rays do not provide images of soft tissues, such as the biceps tendon.
Treatment and Procedure
Both non-surgical and surgical treatment methods are used for biceps tendon ruptures. Tears at the elbow most often require surgery, especially in active individuals. Because there are two attachments to the shoulder, a tear in the shoulder area if often well tolerated and can be treated without surgery.
Non-surgical treatment involves:
- Application of cold packs
- Administration of nonsteroidal anti-inflammatory medications
- Physical therapy
Surgery is not always necessary for partial tears, but may be recommended for very active adults. For complete tears, surgery by an orthopaedic surgeon is often necessary depending on the location. It is imperative to seek an early evaluation as surgery should be performed within two weeks for best results.
Recovery time varies from person to person. After surgery, you will wear a brace for four to six weeks. Rehab begins within the first 3 weeks and involves physical therapy and exercise. It’s also important to listen to the aftercare instructions provided by your doctor to prevent secondary injury.
Frequently Asked Questions
Will a bicep tendon heal itself?
Once a bicep is torn, it unfortunately will not reattach itself to the bone and heal on its own. There are, however, a variety of treatment options available depending on the severity of your injury and whether it was a partial or complete tear.
Some bicep tendon tears will limit your range of motion and may cause pain. Many treatments for this condition involve rest, ice, the use of over-the-counter medications, prescription medications, and avoiding activities that might aggravate or worsen the injury.
How can you prevent a bicep tendon tear?
There are two primary causes of bicep tendon tears: trauma and overuse. The risks of tearing one of your three biceps tendons increase with overuse of your shoulder (common for pitchers, tennis players, and swimmers, as well as in certain careers), heavy overhead activities (common among athletes who lift weights, for instance), age, and the use of corticosteroid medications, which are known to cause weakness in muscles and tendons.
Preventing bicep tendon tears is a multi-stage process that isn’t always foolproof, but there are things you can do to minimize your risks. These include strengthening your back to minimize strain on your biceps and avoiding repetitive overhead lifting activities. A thorough warm-up before participating in physical activities involving the use of your biceps is also imperative to preventing tears.
If you are lifting weights, practice using the “mixed grip” technique to reduce your risk of a bicep tear. A mixed grip having your palms facing in opposite directions: one facing toward your body and one facing away.
Are there non-surgical treatment options for biceps tears?
Dr. O’Grady and his staff at O’Grady Orthopaedics understand your concerns about surgery and will attempt to treat your biceps tendon tears with non-surgical options and expert care that may include the use of cold packs, non-steroidal anti-inflammatory medications, rest, and physical therapy. However, some injuries are too severe for these types of treatments and certain lifestyles demand more aggressive treatment approaches.
If surgery becomes necessary, Dr. O’Grady uses cutting-edge surgical techniques that are minimally invasive to aid your recovery process. Recovery from surgery usually requires you to wear a brace for four to six weeks along with physical therapy, which usually begins within the first three weeks following your surgery.